Parent Name (if student is under 18)

First Name

Last Name

Student Name *

First Name

Last Name

Phone *

XXX-XXX-XXXX

(###)

###

####

Is Student 18 years or Older?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you speak multiple languages?

No

Yes

Do you have prior Arabic experience? *

None

Basic (letters, greetings)

Intermediate (reading, short phrases)

Advanced (conversation, grammar)

What are your goals for Arabic learning? (Click all that apply)

Learn to read Quran

Improve speaking/conversation

Write Arabic

Academic Support

Cultural Enrichment

Other

What is your preferred learning format?

Online

In-Person

Hybrid

Preferred Schedule

Weekday Evenings

Weekends

Would you be interested in office hours for extra help?

Yes

No

Would you be interested in cultural meetups or learning circles?

Yes

No