[PROVISIONAL TRANSLATION FROM PERSIAN]
[Translator’s notes appear in square brackets]
[Personal information has been redacted.]
Islamic Republic of Iran
Date: ---- Month---- Year----
In the Name of God
This letter has been written at the request of the Admissions Council of Al-Zahra University, and pursuant to its report.
In accordance with paragraph 1, Article 11, of Circular No. 1/11331, dated 7/7/1360 [29 September 1981], of the Ministry of Culture and Higher Education, this university cannot register you because of your affiliation with the Baha’i sect. Your registration is only possible if, in the presence of a trusted cleric, you declare that you are no longer a follower of the Baha’i sect and publish announcements to this effect in a number of widely-read national newspapers. In order to determine the status of your [university] registration, please present yourself at the Department of Academic Jihad at Al-Zahra University on 5/5/1361 [27 July 1982] between 8:00 a.m. and 12:00 p.m.
Management Board, Department of Academic Jihad, Al-Zahra University
[signature over official stamp]