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MASLAKUL IRSHAAD ACADEMY (MIA) - ADULT EDUCATION CLASS REGISTRATION

Assalam Alaikum Warahmatullahi Wabarakatuhu Sir/ Madam,
I hope this message finds you in the best of health and iman. 
I am pleased to welcome you to the MIA family. 
This questionnaire has been thoughtfully prepared to help us get to know you better as you begin your journey with us.
Kindly take a few moments to complete it with sincerity. Please be rest assured that all information provided will be treated with the utmost confidentiality. May Almighty Allah in His infinite mercy bless our efforts. Ameen.
JazakumulLahu khoyron
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1.
Name：
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2.
Passport Photo:
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3.
Your gender
Male
Female
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4.
Your age group:
Under 18
18~25
26~30
31~40
41~50
51~60
Over 60
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5.
Marital status
Unmarried
Married
Divorced
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6.
Please enter your phone number:
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7.
Nationality:
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8.
Your current occupation：
Marketing/Sales/Business
Purchasing
Administration
Human Resources
Product/Operations Personnel
Individual entrepreneurs
Finance/Accounting/Cashier/Auditing
Corporate Managers
Lawyers/Legal affairs
Design practitioners
Service industry personnel
Technical development/Engineers
Primary sector workers
Workers
Full-time housewife/husband
Freelancers
Retired
Students
Teachers
Medical staff
Scientific researchers
Party and government officials
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9.
Your educational background:
Junior high school and below
High school / Vocational school / Technical school
College (Associate degree)
Undergraduate (Bachelor's degree)
Graduate and above
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10.
What Aspect of Our Adult Education Class Are you Interested in:
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11.
For the qur'an/ arabic class, what is your level of qiroah (recitation)[Checkboxes]
Beginner
Intermediate
Advanced
Not qur'an/ arabic class
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12.
In terms of qur'an hifz (memorization); are you a beginner? If not, kindly state how many juz/ ajzaa you have memorized. If not registering for a qur'an class; please type NO.
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13.
Please enter your email
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14.
Mention three days of the week that work best for your classes, with time details.
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15.
Name and Contact Details of Next of Kin:
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16.
Relationship with Next of Kin:
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17.
Please enter your address：
Name：
Name：
Street Address：
Street Address：
ZIP/Postal code:
ZIP/Postal code:
City/Town:
City/Town:
State/Province:
State/Province:
Country and Region：
Country and Region：
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18.
Signature:
Please draw within the rectangle area below
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19.
Date:
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