Sponsorship Request Form

Foundations Program Sponsorship Request Form

The cost of the Foundations Program is $99 USD/month. The additional cost for each family member living at the same residence is $25 USD/month.

Student Information:

First Name*

Last Name*

Phone*

Email*

If you participated in the Early-Access Program in the summer of 2020, please indicate to what degree you watched all the classes (recorded and live). Also, please indicate how many reflections you have submitted.

Please describe in detail why you feel this program is important for you.*

Please explain your reasons and the circumstances surrounding your request for financial assistance.*

Please list and provide contact for at least 2 references. One personal and one professional:*

Please note: Al-Madina can only provide a limited amount of subsidies for a given year. Not all recipients will be awarded sponsorship. Applicants cannot submit multiple sponsorship requests.