Enrol Now

First Name (required)

Last Name
(required)

Gender (required)
MaleFemale

Phone(home)

Phone(cell)



Email (required)

Emergency Contact Name



Emergency Contact Phone

Birth Date:

Parent Name (required)

City/State/Zip (required)

Ethnicity

Address

Courses interested to apply for (Please tick appropriately)
QuranIslamiyat

Scholarship on (Financial Hardship)
Yes

Student Agreement:
I agree to abide by all Saleheen policies and procedures.
I agree to pay Saleheen tuition fees and any reasonable collection costs if applicable.