Alim Course (16+) Form

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DETAILS OF APPLICANT
Forename (s)
Surname
Please tick the time you wish to joinFor ladies only
Please select where you will be attending the courseFirst year students only
D.O.BDate of Birth (dd/mm/yyy)
Age

Minimum entry age is 16+

Address
0 /
City

Please note that the online option is only for students outside of Leicester.

Post Code
Telephone Number
Mobile
Occupation
Emergency Contact Name
Emergency Contact Number
Do you suffer from any medical condition or health issues?
Please give details:
0 /

Previous Islamic Education

Please give details of any previous Islamic education including any knowledge of the Arabic language.
0 /
I confirm that all information provided is correct.
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