Surname Name *

First Name *

Middle Name

Date of Birth *

Age *

Nationality *

State Of Origin *

Local Government Area *

Program of Choice *
—Please choose an option—Pre-NurseryNurseryPrimaryJunior SecondarySenior Secondary

Previous School Attended *

Candidate Passport Upload

Name Of Parent/Guardian *

Occupation Of Parent/Guardian *

Office Address Of Parent/Guardian *

Residential Address Of Parent/Guardian *

Phone Number Of Parent/Guardian *

Relationship To The Child *

Email *

What is your child's Genotype? *

Is your child/ward asthmatic?
NOYES

Does your child have any other medical challenge or form of allergy that the school needs to know about? If yes, please specify.

Has your child/ward ever been diagnosed as having special learning difficulties such as Dyslexia, ADHD or any other?
NOYES

Is there any form of food that your child reacts to? If yes, please specify.

On a scale of 1-10, how would you rate your child's academic performance in Islamiyyah?
12345678910

On a scale of 1-10, how would you rate your child's academic performance in Tahfeez?
12345678910

On a scale of 1-10, how would you rate your child's academic performance in Conventional?
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State any other information you think we need to know about your child that will help us curtail all challenges