MEMBERSHIP REGISTRATION FORM

1) PERSONAL INFORMATION
a) FULL NAME
b) NATIONALITY
c) SEX
d) MARITIAL STATUS
e) MOBILE NO.
f) E-MAIL ADDRESS

2) UNIVERSITY INFORMATION
a) REGISTRATION NUMBER
b) FACULTY/ COURSE
c) DATE OF ADMISSION
d) EXPECTED DATE OF COMPLETION
e) HOSTEL-BLOCK-ROOM NO
f) OTHER TYPE OF ACCOMODATION (if any)

3) EDUCATIONAL BACKGROUND
LEVEL OF EDUCATION
a) PRIMARY SCHOOL
b) O LEVEL
c) A LEVEL
d) COLLEGE ATTENDED (if any)

NAME OF THE SCHOOL

REGION

FROM-TO (YEARS)

4) LEVEL OF RELIGIOUS EDUCATION (tick the relevant level attained)

a.) Did not attend madrassa
b.) Attended madrassa to juzuu amma level
c.) Attended madrassa to mas-haf level
d.) Attended madrassa and competent to certain level in :
*arabic language
*qur-an
*hadith
*fiqh
*shariah

5) LEADERSHIP EXPERIENCE
Give your leadership experience from previous institution (any, whether religious or non religious) ............................
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6) IMPORTANT CONTACT PERSON

Give name and address of any of your relatives in dar es salaam or upcountry who should be contacted in case
of any emergency:
a.) FULL NAME
b.) POSTAL ADDRESS
c.) TEL NO/ MOBILE
d.) EMAIL
e.) RELATIONSHIP WITH THE MEMBER
f.) MEMBERS SIGNATURE

7.) FOR OFFICIAL USE ONLY

RECEIVED ON
REMARKS
MEMBERSHIP NUMBER
DATE
NAME OF MSAMU OFFICIAL
SIGNATURE OF MSAMU OFFICIAL