[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

In the Name of God

Enclosure 2

 

Application Form for Registration of Students Accepted at The Cross-Country Exams of the Islamic Azad University

Unit / University Centre -----

Do not write in this space.

Year of exam acceptance: ----- Volunteer number: ----- Total grades: ----- Rank: -----

Type of acceptance: Accepted: ---- Waiting list: ----

Educational discipline: Full-time: --- Part-time: --- Regular admission: --- Quota admission: ---

Quota Type ----- Native -----

 

Fill in the following with exact and legible information as recorded in your birth certificate and other authentic documents.

A) Student’s birth certificate information:

1.Name: -----; 2. Family name: -----; 3. Father’s name: -----; 4. Birth certificate number: -----; 5. Place of issue: District ----- City: ----- Province: -----; 6. Place of birth: (city or village) ----- Province: -----;      7. Date of birth: 13--/----/----; 8. Date of issue: 13--/----/----; 9. Gender: Female: ---- Male: ----;           10. Citizenship -----; 11. Religion: Islam (Shiite ---- Sunni ----) Christian ----- Jewish -----    Zoroastrian -----

B) Student’s educational background based on final educational documents:

Old system high school diploma ---- I have completed the new system pre-university courses ---- College certificate: ---- Bachelor’s ---- Master’s ---- Doctorate ---- Field Education ----- in the area of: ----- I graduated from (High School: ----- University: ----- School of Theology: -----) City: ----- Province: ----- in the year: -----.