Application Form by Mogammad 7 December 2019 Apply Online Form 1A - Application Personal DetailsTitle Mr Mrs Ms Miss Dr Other *First Name*Surname*Date of BirthMaiden SurnameGender Male Female *Home Language*Are you a South African Citizen? Yes No *Are you a South African Permanent Resident? Yes No South Africa ID NumberIf you are not a Citizen or Permanent Resident please complete belowCountry of ResidencePassport NumberForm 1B - Applicant Contact Details*Home AddressPostal CodePostal Address (if different to home address)Telephone Number (include country and area code)*Mobile Number*Email AddressForm 1C - Parent/Spouse/Guardian Details*Name*Relationship*ID / Passport NumberPostal Address (if different to Street Address)Please Note: This information will be used as a reference for Next of KinForm 2 - Study Programme Applying For*In which year do you want to commence your studies 2025 2026 2027 2028 Select the Programme Hifth Foundation in Islamic Studies 1 year Usul-al-Din 3 year BA in Islamic Studies Note: an applicant who wishes to apply to study the 2nd or 3rd year must please submit all qualifications from your previous Institute of learning You may be required to submit subject records where applicable/requested*Academic Year 1st 2nd 3rd Madina Institute NPC is provisionally registered with the Department of Higher Education and Training until 31 December 2021 as a private higher education institution under the Act Registration certificate No 2018/HE08/00Form 3A - Current Matric Student School DetailsSchool NameExam NumberSchool Code - Completed by AdminSchool AddressSchool Subject and Latest ResultForm 3B - Post Matric or Foreign Student School DetailsPrior tertiary qualification: (please list all institutes registered at – if applicable)School Name and AddressExam YearSchool Subject and ResultsForeign Students OnlyStudent NumberYear of StudySchool Leaving QualificationReturning Students (Alumni)Year of Study at Madina InstituteStudent NumPlease list the followingHighest Qualification AchievedYear, Institute, Qualification Studied, Completed(Y/N)Form 4A - Person Responsible for Paying the Fees (Mandatory)Fee Payer Title Mr Mrs Ms Miss Dr Prof *Fee Payer Name*Fee Payer Surname*Relationship of Fee Payer*Fee Payer ID / Passport Number*Fee Payer Home Address*Fee Payer Postal CodeFee Payer Telephone Number*Fee Payer Mobile Number*Fee Payer Email AddressCompulsory PaymentsApplication FeeR250 (Two Hundred and Fifty Rands) payable with applicationRegistration FeeR1000 (One Thousand Rands) payable at RegistrationFees Payment AgreementA Discount of 10% when paying the full course fees will be granted if settled before 31 March of year of study*Payment Plan: I would like my payment for the course to be split as follows: max 10 Months 1 2 3 4 5 6 7 8 9 10 Scholarship Application ProcessForm 4B - Supporting Financial DetailsPlease only fill out this section if you require financial aidList Sources of Income - 1List Sources of Income - 2List Sources of Income - 3Total Household IncomeTotal Household ExpensesTotal Monthly Expenses is broken down into the following categories (Rand Value)FoodRentalHire PurchaseElectricity, Water & RatesClothingCourt OrdersSubscriptions (DSTV, etc)School FeesTelephone / Cell PhoneOther -Contribution Towards Study Fees - In case full scholarship is not approved)A Discount of 5% when paying the portion of the course fees will be granted if settled before 31 MarchI can afford to pay the following amount towards the feesForm S1 - Proficiency RequirementsIslamic StudiesInstitution NameCourse(s) CompletedDate CompletedAjaza CompletedArabic Reading ProficiencyRate your level of proficiency*Quran Recitation None Beginner Intermediate Advanced Arabic Text None Beginner Intermediate Advanced Form S2 - TestimonialsExtracurricular Activity and Community Service*List any Extracurricular activities that you have been involved in:*List any Community Service activities that you have been involved in:Please attach any relevant documentation to your applicationMax file size of 30 MB and the following formats are allowed: jpg,jpeg,png,doc,docx,pdf,rtf,odt,txt*Certified Copy of ID Document, valid passport (if foreign Student)*Certified Proof of residential address Less than 3 months old*Most recent school Report (if in Matric – Grade 11 report otherwise your most recent School finishing report)*Motivation Letter for Applying (1 Page)*Application Fee - Proof of PaymentThis is to certify that shall I be accepted into the Madina Institute programmes, the fees and additional conditions as described in the admission rules will be adhered to*I accept Yes No Note : Students may have to be interview by Madina Institute lecturers prior to acceptancePlease submit your application below. We thank you for your application and wish you all the success. Should you have trouble during the process, do not despair, contact us on info@madinainstitute.ac.za and we will be glad to assist in completing your application on our side. Fields with (*) are compulsory.
