Skip Navigation

Request Information

Thank you for your interest in Islamic Center of Johnson County!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

If you are interested in more than one program (IQRA Weekend Academy or IQRA Weekday Institute), please fill out this Inquiry form again and select a different program grade level of interest.


* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us?
    Details:

  • Does your child have any learning differences, medical conditions, or other needs we should be aware of to help them have a safe and successful experience?
    *

  • Do you already have any older children enrolled at ICJC in IQRA Institute or IQRA Weekend Academy? if yes, please list their names. 
    *

  • Which Parent is responsible financially for completing the enrollment packet and payment for tutition? (Please type name of one parent only please)
    *

  • I would like to register my child for 
    *
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Email Address
    Confirm Email Address
  • Grade Level of Interest *
    School Year *
  • Current School *

  • Student Preferred Name (if not first name)

  • Is you this student in School?

  • What previous Islamic School or Quran schools have you attended? "None" if this is the first Islamic Institution 
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •