Young IMSA Leadership: Shaping Tomorrow's Leaders Today!

YIL New Student Registration

Registration for New YIL Student

Student Name *

Gender *

Male

Female

Date of Birth *

School Grade (as per Fall this year) *

Student's phone number/ WhatsApp number for the student who already owns it.

PS: Admin will send a consent form to the student to ensure that the student agrees to join the YIL Program.

If the student does not reply within a week after the Admin sends the consent form, then the seat will go to the next on the waitlist. If the student does not have a phone number, please ignore this part. (Younger students at the elementary level are less likely to have a phone number, inshaaAllah their parents can ensure the child can join the weekly halaqa without any difficulty).

Phone Whatsapp

Student's Email Address *

Student's Home Address *

State Where Student Lives

Parents Information

Mother's Name *

Mother's Phone Number *

Mother's Email *

Father's Name *

Father's Phone Number *

Father's Email *

Young IMSA Leadership: Shaping Tomorrow's Leaders Today!

Young IMSA Leadership: Shaping Tomorrow's Leaders Today!

YIL New Student Registration

Registration for New YIL Student

Registration for New YIL Student

Parents Information

Indonesian Muslim Society in America

Indonesian Muslim Society in America