Please submit only ONE application per child

Student Enrollment Application

Interested School Year*

Primary Home/Residential Address*

Street Address, City, State Zip Code

Have you completed a Campus Tour?*

Yes

Student Information

Student Name*

First, Middle, and Last Name (eg. Abdullah, Ahmed, Khan)

What grade will your child be in the 2025/2026 school year?*

School Track*

Regular Academics = Islamic Studies, Quranic Studies, Language Arts, Math, Science, & History

Hifdh & Academics = Quran Memorization, Language Arts, Math, Science, & History

Only Hifdh = Quran Memorization at Zaytech Academy, academics elsewhere

*Hifdh Requirements: 5th Grade and above, must pass memorization readiness evaluation by Zaytech Academy Hifdh teachers

Gender*

Female

Male

Date of Birth*

Month/Day/Year

What school does your child currently attend?*

Child's Discipline History at Current/Previous School*

None

Received Detention

Suspended

Expelled

Held back grade level(s)

Other

Parent(s)/Guardian(s) Information

Primary Parent/Guardian Details

Primary Parent/Guardian First Name*

Primary Parent/Guardian Last Name*

Primary Parent/Guardian Email Address*

Primary Parent/Guardian Phone #*

Primary Parent/Guardian Relationship to Child*

Secondary Parent/Guardian Details

Secondary Parent/Guardian First Name*

Secondary Parent/Guardian Last Name*

Secondary Parent/Guardian Email Address*

Secondary Parent/Guardian Phone #*

Secondary Parent/Guardian Relationship to Child*

Financial Information

Any data collected is solely for the purpose of Zaytech Academy admissions, and will not be shared with anyone outside of the Zaytech Academy admissions team.

Household Size*

# of people in your household

Household Annual Income

Gross Estimated Amount (Before Taxes)

It is not required to provide this information - but recommended.

Student Enrollment Application - Questionnaire

Before clicking the "Continue to Application Fee" button below, please complete the Student Enrollment Application - Questionnaire here:

https://forms.gle/n5kyLhQKDs1bzdoa8

Before clicking the "Continue to Application Fee" button below, please complete the Student Enrollment Application - Questionnaire here:

https://forms.gle/n5kyLhQKDs1bzdoa8

**Please submit only ONE application per child**