Tuition Assistance Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Card Stripe Date Student Information Name *FirstLastStudent Email *Phone (optional)Date of Birth *Reasons for Assistance Brief Explanation of Need: *Consent and Declaration I hereby certify that the information provided in this application is true and accurate to the best of my knowledge. I authorize the institution to verify the information provided. Student Signature * Clear Signature Payment Choose how much you are able to pay monthly. This amount with automatically be charged every 30 days until the last day of the program. There is a $25 minimum If you would like to change the amount later please reach out to our support team at islamicinstituteoftx@gmail.com Monthly Payment: *This amount will automatically be charged every 30 days until the end of the program.Minimum Price: $25.00Stripe Credit Card *Submit
