In the Name of Allah the Most Merciful and the Most Beneficent

In the name of Allah the Most Merciful and the Most Beneficent.

Assalamu-Alaikum Dear Parents,

"A father gives his child nothing better than a good education (intellectual and moral)"- Tirmidhi

We know that you have a choice in selecting the right school for your beloved children. Thank you and Congratulations on choosing Salam Academy for your child. This registration package has been carefully designed to acquaint you with our school and includes information to assist you as you carefully consider the educational opportunities available for your children.

The pursuit of quality education for your child is an obligation. The choice of an Islamic school is an important one. At Salam Academy, our constant endeavor is to offer opportunities for each student to grow academically, spiritually, socially and physically. We at Salam Academy work very hard to achieve these great goals. Salam Academy follows the State of TX TEKS curriculum for Math English, Science, Social Studies, Technology, and other contemporary subjects. Being an Islamic School we have additional subjects on Islamic Studies, Quran, Arabic with a lot of emphasis on Tarbiah. This balance of contemporary school education in tandem with Islamic Education for a reasonable cost makes Salam Academy a unique and the only Islamic Magnet School nationwide till this day offering such services in USA.

The progress of our students is a continuous source of pride for us as we see them performing very well compared to other students locally, statewide, and nationally. Alhamdu-Lillah. For the past several years all our students passed Texas TAKS/STAAR tests making Salam Academy an Exemplary School. Alhamdulillah our students also take the National CTBS tests and the results speak about the quality of our education.

This academic year, we continue to focus on enriching and diversifying the curriculum offerings. We will achieve this by reinforcing our regular curriculum with a wide array of extra school activities to stimulate learning and discovery.

·  We have moved to a new, bigger and better facility and will be upgrading our infrastructure including but not limited to state of art Science labs, expanding the current computer lab, addition of high tech teaching aids, etc.

·  We already have an option for Hifz program integrated in our syllabus for students and parents wishing to enroll in Hifz–Ul-Quran, but also have added after school academic program for full time Hifz Students.

·  Salam Academy participates in many academic competitions such as Science Fair, PSIA, Quran and Islamic Education Contests. These contests may be Local, County, State, and/or National Level.

·  We now prepare our students for the High School Collegiate and Dual Credit program in collaboration with Richland Community College.

Our well trained dedicated team welcomes you and your child (ren) to Current Academic year at Salam Academy. We hope this will the best experience for you and your family Inshallah!

Please call the school office with any questions you may have about the admission process. You may also email us at:

With Best Regards

Administration

Fee Schedule for 2015 -2016

***Pre-School fees and application is separate.

ONE-TIME FEES PER CHILD

/ Registration / Tuition
Registration Processing Fee / $150 / $2500 / Year
Books & Materials Fee / $350
PERIODIC FEES SCHEDULE – $250/Month for Ten (10) Months due 1st of each month
(A LATE FEE OF $25 WILL APPLY AFTER THE 5TH OF EACH MONTH)
Sibling Discount:
1st Child = $250.00 2nd Child = $225.00
3rd Child = $200.00 4th Child = $ 175.00
5th Child and up free
MONTHLY TUTION FEES FOR HIFDH & QURAN RECITATION PROGRAMS
Hifdh – Full Time (8 AM – 3 PM) / $250.00
Study Island After School Program for Full Time Hifdh Students / $150.00
Hifdh – Part Time / $150.00
Quran Recitation/Nazira program After School / $50.00
*Extended After Care: Available until 6 PM for an additional fee of $100/month,
regardless of # of days your child attended school.

If a payment is not received by the 10th of the month, the student may not attend school until payment is received. Your child will be dismissed if a payment is not received by the 1st of the following month. There will be a $25 charge for any returned check. Tuition installment is due in full regardless of the number of days your child has attended school. You are responsible of making payment regardless of number of months your child attended school (10 installments).

NOTE:
For your application to be accepted, all Registration, Books and Materials Fees must be submitted with the application. ALL Fees are non-refundable.

I agree and commit to making timely prompt payments as stipulated in this fee schedule.

______

Signature of parent Date

ENROLLMENT FORM FOR 2015 – 2016

Grade Applying For: ______

IMPORTANT DATES (Please complete all information)
Early Registration Starts / : / April 7th – May 7th 2015
Financial Assistance Application Deadline / : / July 31st 2015

OFFICE USE ONLY

Account # ______Application Date: __ ___ Admission Date: ______

Withdrawal Date: ______All dues paid Turn-in all books/library books/materials

Registration Fee: ______Auto Withdrawal Card Cash

Books/Material Fee: ______Auto Withdrawal Card Cash

Enrollment Checklist:

Application Checked Enrollment Contract Parent Acknowledgement Birth Certificate Immunization Record Emergency Card Previous School Record

Placement Test Date: ______by: ______

Comments: ______

PERSONAL INFORMATION
1.  Child’s Name ______
(Last Name) (First Name) (Middle)
2.  Date of Birth : / / Male Female SS#______- ______- ______
3.  Home Address : ______
(Street) (City) (State) (Zip Code)
Home Phone ______Race/Ethnic origin -______
4.  Father’s Name :______Work Phone: ______
E-mail : ______ Occupation: ______
Home Address (If different from child’s address) : ______
Employer Name and Address : ______
Highest Education Completed : Doctoral Masters Bachelor High School
Marital Status : ______
5.  Mother’s Name :______Work Phone: ______
E-mail : ______ Occupation: ______
Home Address (If different from child’s address) : ______
Employer Name and Address : ______
Highest Education Completed : Doctoral Masters Bachelor High School
Marital Status : ______
Family income: ______ Weekly Bi-weekly Monthly Annually
CONTACT INFORMATION AND RELEASE DIRECTIONS
List ALL Telephone Numbers where Parents / Guardian may be reached while child will be in school / Mother’s Telephone No. / Father’s Telephone No. / Guardian’s Telephone No.
In case of emergency, give name of person of to be contacted if parents / guardian cannot be reached at the above numbers / Name and Phone Number / Relationship to Student
I hereby authorize Salam Academy to allow my child to leave the facility ONLY with the following persons (other than parents/guardian) / Name and Phone Number / Relationship to Student
Name and Phone Number / Relationship to Student
CURRENT AND PAST MEDICAL CONDITIONS
List any special problems that your child may have such as allergies, existing illness, previous serious illness, injuries during the past 12 months, any medications prescribed for long term continuous use and any other information which our staff should be aware of :
______
______
OTHER INFORMATION
Salam Academy is strongly committed to meeting the needs of its students. In order to provide programs and resources to meet students' needs, Salam Academy seeks accurate and timely information from prospective families regarding the learning history of applicants for admission.
1.  List the public school district in which your child resides:
2.  List all previous schools attended (List most recent first):
Name of School: ______Grade : ______Year : ______

School Phone Number: ______

Address: ______ZIP Code: ______

Name of School: ______Grade: ______Year: ______

School Phone Number: ______

Address: ______ZIP Code: ______

Reason for leaving previous school (s) ______

3.  Has the student ever repeated a grade? If yes, describe which grade and why.
4.  Has the student ever been suspended, expelled, or received any disciplinary action in school? If yes, describe which grade and why.
5.  Does your child have any physical disabilities? If yes, please explain.
______
______
6.  Has your child been referred for (check one of the following):
Learning disabilities Language processing ADHD / ADD Emotional difficulties
7.  Has your child been tested for (check one of the following):
Learning disabilities Language processing ADHD/ADD Emotional difficulties
Initial test date ______Most recent test date ______Please submit a copy of most recent test result.
8.  If yes, please explain.
______
9.  List the subjects in which you believe your child excels -______
10.  List the subjects which you believe are difficult for your child-______
11.  List any extracurricular school activities your child has participated in during the last school year, ex. clubs, Masjid activities, sports, or special programs- ______
12.  The student lives with :
Both Parents Father Mother Other ______
Please give name, school and grade siblings are attending
______
______
13.  Please share your reasons for applying to Salam Academy ______
______
AUTHORIZATION FOR EMERGENCY MEDICAL ATTENTION
In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize Salam Academy’s Director or person in charge to take my child to :
To the Nearest Hospital / medical facility OR
Name of Physician :
/ Address : / Phone Number :
Name of Hospital :
/ Address : / Phone Number :
I give consent for Salam Academy to secure any and all necessary medical care for my child. I absolve Salam Academy from liability to my child because of injury in the school, field trip or other school activity away from school. I further understand that Salam Academy will not be responsible for any charges / expenses incurred as a result of emergency/urgent / first aid medical attention provided to my child. I bear full responsibility for expenses of this nature.
X______
Signature of Parent / Guardian
CONSENT & ACKNOWLEDGEMENTS
TRANSPORTATION I hereby give do not give my consent for my child to be transported and
supervised by the school staff on field trips
WALKING HOME I hereby give do not give my consent for my child to be allowed to walk home or
to be released to the care of the named sibling ______
who is under the age of 18 years
WATER ACTIVITIES I hereby give do not give my consent for my child to participate in water activities
sprinklers splashing pools swimming pools other bodies of water
FIELD TRIPS I hereby give do not give my consent for my child to participate in field trips.
PARENT COMMENTS
______
ACKNOWLEDGEMENTS
I acknowledge receipt of “Salam Academy Student Handbook”. I further understand that the school policies and procedures are available for review at the school office.
X______
Signature of Parent / Guardian

To the best of my ability, I/we have provided accurate and truthful information on this application for admission. I understand and agree that the admissions process cannot be completed until Salam Academy has received all required documents. I understand that incorrect and incomplete information and late or non-payment of fees and /or tuition may result in delays and possible declination of admission. I understand that all registration fees are non-refundable.

All new students are on probation for the first three months.

Parent/Guardian’s Signature: ______Date: ______

Name: ______Relationship to Student: ______

Automatic Payment Form 2015 – 2016

*Student’s Name: *Grade:

Grade:

Grade:

Grade:

*Parent/Guardian/Sponsor Name:

*Phone: Home Work

*E-Mail:

*Total Amount (Tuition Fees/Books, etc.): *Monthly Amount:

X Signature: Date:

I give permission to Salam Academy to withdraw tuition fees and other charges related to the above student(s) from my account each month. I will submit written approval of changes or termination within reasonable time to adjust the records accordingly.

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Credit Card Payment:

*Card#:

*Expiration Date: / / CVV Code:______

*Name (as it appears on the card):

*Billing Address: ___

*Phone number:______*E-Mail Address:______

* Fields marked with an * must be filled out.

ENROLLMENT AGREEMENT (2015 – 2016) (Note: Complete only one for all children)

Name of Student : ______
/ Grade : ______
Name of Student : ______
/ Grade : ______
Name of Student : ______
/ Grade : ______
Name of Student : ______
/ Grade : ______

I hereby place my confidence in the ability of the administration and staff of Salam Academy to perform the educational function due to my child (ren) at their discretion.

I agree to accept all regulations of the school on the applicant's behalf and authorize Salam Academy to employ such discipline, as it deems wise and expedient for my child (ren). I realize that occasionally children may make an issue with actions that they do not agree with and that they are prone to take teacher criticisms out of context. I pledge that if this should occur, I will seek to clarify the matter with the teacher and / or Principal first. If necessary, I will correct my child (ren) and will support the school personnel. I will follow the same procedure for any school incidents that may occur.

I pledge to build a strong relation with my child(ren)'s teachers and aid in the training of my child(ren) by providing an Islamic example at home, supporting the spiritual training of the school, following through with any work assignments or slips to be signed, ensuring that my child(ren) arrive(s) at school on time, sending in written excuses for absences or tardiness, teaching my child(ren) to respect school property, and attending all events/meetings for parents.

As stated in the authorization section of the enrollment form, in the event my child (ren) become(s) ill or is injured at school and I cannot be reached, Salam Academy is authorized to contact the person(s) listed in the application form, or to transport my child (ren) to the nearest hospital and is given consent for emergency care depending on the severity of the illness or injury. I absolve Salam Academy from liability to my child because of injury in the school, field trip or other school activity away from school. The school is NOT financially responsible for any emergency care/hospital expenses or transportation. I understand that a large part of Salam Academy operations are sustained by charitable donations, and for fundraising and other promotional purposes. Salam Academy may conduct video, still photography, display of student work and live performances throughout the academic year. I agree that unless I submit a written statement to the contrary, Salam Academy has my consent and support to include my child (ren) in such promotional activity.