Tuition Assistance Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.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 Student Date Explanation 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
