Swansea Mosque Islamic Academy
Islamic Studies Course (Ages 14+) - Sisters
Student Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Post Code
Student Age Group
*
Please Select
Adult
Child(14yrs+)
Parent/Guardian Name (if Student a child)
First Name
Last Name
Student Level
Please Select
Qaida (Beginner)
Juz Amma (Intermediate)
Quran (Advanced)
Request Assessment (Don't Know Level)
Student/Parent Email
*
example@example.com
Same Address As Student?
Yes
No
Address of Fee Payer
Street Address
Street Address Line 2
City
State / Province
Post Code
Student/Parent Phone Number
*
Please enter a valid phone number.
Submit
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