[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: -----.