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2024-2025 ILTDP Student Application
Application for admittance into the ILTDP. Complete the form.
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* Indicates required question
Email
*
Your email
First and last name (Legal Name)?
*
Your answer
Preferred name for class use (e.g., Muslim Name, if different from your legal name)?
*
Your answer
Address (house number, apt #., and street)
*
Your answer
City
*
Your answer
State (two-letter abbreviation)
*
Your answer
Zip Code
*
Your answer
Phone Number
*
Your answer
Masjid or Islamic Center
*
Your answer
City of Masjid or Islamic Center
*
Your answer
Resident Imam's Name
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Your answer
Resident Imam's Cell Phone Number
*
Your answer
COMMUNITY PARTICIPATION
This section is about your participation in the Muslim and outer community
Which categories best describes your experiences serving the Islamic Community? (check all that apply):
Community worker
Khatib: Occasional Khutbah or Community Presentation
Islamic Teacher
Islamic Chaplain
Imam/Assistant Imam
Shuraa Board Member
Other:
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