New Student Registration

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In order to be able to resume this form later, please enter your email and choose a password.

Password must contain the following:
  • 12 Characters
  • 1 Uppercase letter
  • 1 Lowercase letter
  • 1 Number
  • 1 Special character
For ONLY new students, who have never been enrolled in an ILIA class.
If you're not sure, please check your admission status here before completing this form.

* Even if you have only attended a free ILIA event in the past, you may already be considered admitted. Check using the form above to make sure before completing this form.
Student Information









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Briefly share your short-term goals and longer-term life mission.

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Backend Processing

Can be "Paid" or "Free". Defaults to a paid form if blank.

Student Contact Information










Emails do not match.

Education

If you are currently in school, enter information about your current school. Otherwise, enter information about the last educational institution you attended.






Parent/Guardian Information





Guardian 1 Information




Guardian 2 Information




Medical History





Please select any allergies you have.

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References

Reference 1
Can be a school teacher, coach or mentor.





Reference 2
Can be an imam, community leader, or school administrator.





Payment

There is a one-time, nonrefundable $50.00 fee for student sign-ups.

If provided with one, enter your discount code here


Financial Aid Instructions
Please complete a zakat application. Applications available online here.

Please reach out to us at ss@islamicleadership.org for any questions regarding financial aid.

Payment Information

$