London Open College

LOC Registration Form

Fields marked with a * are required.

Personal Data

Languge*

Arabic English

Title

Full Name in Arabic*

Surname*

Forename*

Middle Name

Password*

Confirm Password*

Street Name*

Area

City*

PostCode*

Country of Residence*

Telephone

Mobile

Fax

Email*

Sex*

Male Female

Marital Status

Date of Birth*

Nationality*

Country of Birth*

Preferred method for fees payment*

Online (credit card) Cheque Postal Order
Other (Please specify)

Special needs/ Disability

Previous Qualifications

Please choose one from the following*

A levels (or equivalents: e.g. High school, international baccalaureate, etc.) GCSE None From the Above

Establishment Name*

Address*

Max Size : 255 Letter

Cerificate Name*

Cerificate Date*

Cerificate Grade

Cerificate Study Language*

Establishment Name

Address

Cerificate Name

Cerificate Date

Cerificate Grade

Cerificate Study Language

Programme Details

How did you hear about LOC

from a student from a friend from LOC Internet Poster in an Islamic centre an advert in Al-Bayan magazine Muslim Directory Other (Please specify)

Language of instruction*

Language of instruction

Arabic English

Fluency

Reading :
Writing :
Speaking :

Nearest Islamic Center

Name of your nearest Islamic Centre

Address

Phone

Fax

Name of a person from the Centre that can be contacted

Please state the reason(s) behind your decision to join LOC as a student

Max Size : 250 Letter

Family Member/Friend

Please give details about a family Member/Friend that we can contact in emergencies where it is not possible to contact you

Surname

Forename

Address

PostCode

Country

TelePhone

Fax

I confirm that all information I stated are correct.