AL-Azhar InstituteOnline Application FormNOTE:This form must be completed in full. All changes ro be initialed by the parent/guardian. Completing the form does not necessarily mean that the leaner has been accepted into the school.Grade Applied ForHighest Grade PassedYear when Grade was PassedAccession No:Learner's DetailsSurnameFirst NameInitialsNick NameOther NamesDate of BirthGenderIdentification/Passport No:RaceCountry of ResidenceCitizenshipIF SA, INDICATE PROVINCE OF RESIDENCEStreet AddressHouse,Apartment, suite, etcCityState/ProvincePostal CodeHome TelephoneEmergency TelephoneLearner's CellEmail AddressHome LanguagePreferred Language of InstructionBoarderYesNoDeceased ParentMotherFatherBoth DeceasedMode of TransportReligionFor Grade 1 Only: Indicate pre-primary educationNoneNon formalFormalReligionPrevious School InformationName of Previous SchoolPrevious School AddressCodeProvinceGountryLearner Medical InformationMedical Aid NumberMedical Aid NameMedical Aid Main NumberDoctor's NameDoctor's AddressDoctor's Phone NumberMedical ConditionSpecial Problems Requiring CounselingDexterity ofLearnerRight HandedLeft HandedAmbidextrousRegistered For Social GrantYesNoRec Social GrantYesNoNOTEUpload files (PDF/CLEAR SCREENSHOTS)Drag and Drop (or) Choose FilesParents Information SectionComplete a SEPARATE parent form for each parent living at a different physical addressNumber of Children at this schoolPosition in the family of current leanerName of SiblingGradeName of SiblingGradeName of SiblingGradeName of FatherHome LanguageRaceIdentification /Passport numberAccount PayerYesNoStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweOccupationEmployerSpouse DetailsTitleMr.Mrs.Ms.Mx.MissDr.Prof.First NameMiddle NameLast NameOccupation of SpouseLearner resides with his parent/sYesNoSpouse Identification /Passport numberRelationship to LearnerMarital status of parentIf the leaner is accepted, the following documents must be submitted to the school: Copy of Immunisation Records. Copy of birth Certificate. Progress Report from Previous School. Transfer Letter from Previous School. Correspondence DetailsTitleSurnameStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweOther Contact DetailsHome TelephoneWork TelephoneCellphone NumberEmail AddressSpouse Cellphone NumberSpouse Work TelephoneSpouse Email AddressConsentI hereby declare that to the best of my knowledge, the above information as supplied is accurate and correct.Signature of Parent /GuardianStart signing your signature hereYour browser does not support e-Signature field.option to signature is your ID Number & NameName of ParentDatePayment DetailsPLEASE NOTESchool fees can be PAYABLE in advancePerson Responsible for paying school feesID/Passport NumberConsentI above signed, being parent/guardian/caregiver of the learner enrolled at AL-Azhar Institute Johannesburg for the academic year of 2024. Hereby consent to further steps being taken (in any way the institution deems fit) should I renege in the payment of said fees. I also pledge my commitment to participate in any school-related projects aimed at raising funds.NameWitness NameContact Details of FatherCOMPULSORYStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCell NumberWork NumberHome NumberContact Details of MotherCOMPULSORYStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCell NumberWork NumberHome NumberFOR OFFICE USE ONLYDateAcceptedAccession NumberRejectedReason for RejectionDocumentation ReceivedYesNoImmunization Record ReceivedYesNoBirth Certificate ReceivedYesNoProgress Report from Previous SchoolYesNoTransfer Letter from Previous SchoolYesNoSUBMIT FORM
