Houghton Muslim Academy

Application Information (Estimated time: 10 Minutes)

Application for admission in

Month

Year

Applying for Grade

A. Student Information

Student Name:

Family/Last Name

First Name

Middle Name

Gender

Date of Birth:

Birthplace

Home Language(s)

Previous School(s)

Highest Grade Passed

Sibling(s) Applying to HMA - Name and Grade

Sibling(s) Enrolled in HMA - Name and Grade

Learner Dexterity

Right Handed

Left Handed

Ambidextrous

B. Family Information

Parent/Guardian 1

First Name

Last Name

Nationality

Email Address

Cellphone

Home Tel

Physical Address

Employer

Profession

Work Telephone

Work Address

Parent/Guardian 2

First Name

Last Name

Nationality

Email Address

Cellphone

Home Tel

Physical Address

Employer

Profession

Work Telephone

Work Address

C. Educational History:

Has your child ever been enrolled at HMA?

Yes

Has your child skipped or repeated a grade?

Yes

Has your child been suspended or expelled from school in the past two years?

Yes

Any concerns of which to make us aware that would help us? (Transition, adjustments, academic)

D. Billing Information:

Financial responsibility of my child will be assumed by:

Relationship

Phone Number

E. Emergency Contact Information (Other than parent)

In the event of an emergency contact

Work Telephone

Mobile Phone

Home Phone

Alternate Phone

About Houghton Muslim Academy

Application Information (Estimated time: 10 Minutes)

A. Student Information

B. Family Information

C. Educational History:

D. Billing Information:

E. Emergency Contact Information (Other than parent)

F. Documents

Medical form

Birth certificate

Parents I.D copies

Indemnity form

Previous school records

Proof of address

Proof of payment of R450

CONTACT

PHASES

SCHOOL

MOBILE