AL-SALAM DAY SCHOOL

519 Weidman Road, St. Louis, MO, 63011

Online Application Form

For currently enrolled families, please use your Orbund Login Username and Password provided to you. If you are unsure of your Orbund email/password, please email ads@alsalamdayschool.org and it will be re-sent to you.

Primary Parent/Guardian

Secondary Parent/Guardian

Emergency Contact Information 1


I will bring in Government issued photo ID to ADS Administration before first day of school

ADS staff will release your child only to you or those persons you have listed above. For the safety of your child, we request all authorized Release Persons with whom staff is not familiar to provide Gov't issued photo ID at time of pick up.

If you want a person who is not identified above to pick up your child/children, you MUST notify school administration in advance.

Your child/children will not be released without prior authorization.

Emergency Contact Information 2

Annual Economic Deprivation Survey for Federal Program Participation (Completed by Parent Or Guardian of Nonpublic Student (One per Family)

INSTRUCTIONS FOR Annual Economic Deprivation Survey For Federal Program Participation

This form may be used to collect information that can be used to determine the amount of federal program services available to this school. It will be kept strictly confidential.

Section 1: Student Information: List the number of children in your household that attend this nonpublic school and the grade level of each child. This must be completed.

Section 2: Household Eligibility Method: Indicate which method determines household eligibility. Otherwise, indicate that the household is not eligible.

Section 3: Signature: All applications must have the signature of an adult household member. Use the following chart to determine if the household is eligible based on income. If the total amount of income of all household members (before taxes or anything else is taken out) exceeds the amount on this chart for your household size, the household is not eligible.

MAXIMUM INCOME TO BE ELIGIBLE: JULY 1, 2017 TO JUNE 30, 2018
Household Size AnnuallyMonthlyWeekly
1 $21,978 $1,832 $423
2 29,637 2,470 570
3 37,296 3,108 718
4 44,955 3,747 865
5 52,614 4,385 1,012
6 60,273 5,023 1,160
7 67,951 5,663 1,307
8 75,647 6,304 1,455
8 For each additional member add +7,696 +642 +148


Number of children in household that attend this nonpublic school:
This MUST be completed.

This MUST be completed.

Household is eligible.
(Select one of the three methods above to determine household eligibility.
Otherwise indicate that the household is not eligible.)

I certify that all of the above information is true and correct and that all income is reported. I understand that this information is being given for receipt of Federal Funds and will be kept confidential at the school.

Signature of Adult Household Member

Annual Check-o-matic Tuition Payment Form (One per Family)


I give permission to the Islamic Foundation
of Greater St. Louis/Al-Salam Day School to withdraw from my bank account the monthly tuition payments I have indicated above.

I also understand that I may change or
end tuition payments at any time with a written notice.

If you are unable to upload a voided check, please bring a copy to our administrative office.

9 digits number preceding bank account number.

Request for Records (New Students Only)


Please agree to fill out and sign this form and immediately return to Al-Salam Day School so that we may request your child's records from their previous school to complete the application process. Thank you.

I authorize the release of my child's school records, including gifted, educational, medical, social or special education information to Al -Salam Day School