Tuition Assistance Request – Appeal Form

Darul Qasim understands and respects that the information you are submitting on this form is confidential and solely for the purpose of potentially receiving assistance for tuition payments.

In consideration of the individual disclosing confidential information on this form Darul Qasim commits to:

not communicate, disclose or make available all or any part of the Confidential Information to any third party
not directly or indirectly use, or permit others to use, the Confidential Information other than for the Purpose other than what the intent of the form is

This form is secure and encrypted for your protection and safety.

Tuition Assistance Appeal

Student ID*
Name*
First Last
Gender*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Email
Which program are you enrolled in?*
Are you supported by the people whose AGI was provided?*
What is your personal disposable income after rent, utilities & food?*
Do you/spouse/your children have loan repayments? List type and monthly payment for each.*
Please provide a statement on why you believe your situation is extraordinary.*