Url 1. Applicant's details Page 1 of 7 Forename(s) * Surname * Other Known Names If this applicant has been known using any other names, please enter it here. Date of Birth * Place of Birth * Address * Postcode * City * Nationality * Right of Abode in the UK * Yes No Permanent UK Resident since * Applicant's spoken language(s) * Ethnicity * Current school year * Year 6 Year 7 Year 8 Year 9 Year 10 Year 11 Over 16 yrs old 2. Parent/Guardian details Page 2 of 7 Forename(s) * Surname * Address different from above? * Yes No Telephone * Mobile * Date of Birth * Place of Birth * Nationality * Occupation * Email * 3. Academic Education details Page 3 of 7 Name of School/College last attended * Address * Postcode * City * Telephone * Duration Attended * Details of Subject studied and Grades/Level Achieved Please indicate with NA if not applicable. Key Stage 2 * Key Stage 3 * GCSE * 4. Islamic Education details Page 4 of 7 Masjid/Madrasah/Darul Uloom last attended * Address * Postcode * City * Telephone * Duration Attended * Completed reciting the whole Quran text * Yes No Have you memorised any part of the Quran? * Yes No If you have attended a Darul Uloom or Islamic Seminary, please complete the section below. Date of Leaving/Intending to Leave Reason for Leaving/Intending to leave Details of Islamic books studied (in Alim class or Madrasah/Maktab) and Grades/Level Achieved 5. Other Details Page 5 of 7 Has the applicant had any involvement with the Police? * Yes No Has the applicant had any involvement with Social/Probation services? * Yes No Does the applicant have SEN (Special Educational Needs)? * Yes No Has the applicant previously applied to the Darul Uloom Leicester * Yes No Has the applicant previously been temporarily or permanently excluded from any previous schools? * Yes No Does the applicant have any medical conditions, allergies or long term illnesses or had any operations. * Yes No Please provide any other information which we should know about the applicant 6. Required Documents Please provide all the required documents listed below. Application will only be processed once we have received all documents. All documents must be scanned and not photographs. Page 6 of 7 Birth Certificate * Passport * Most Recent School Report * Passport size photo * Madrasah/Darul Uloom Report or Letter from Teacher * Character reference letter Required if 16+ years old. KS2 SATs results Requirement for all students applying for school. 7. Information Summary Page 7 of 7 Declaration Please confirm: * I verify that all information I have provided on this form is true and correct to the best of my knowledge at the time of submitting. First Name * Last Name * Date *
