[Translator’s notes appear in square brackets]

[Personal information has been redacted.]


[The specific questionnaire from the Ministry of Education for enrolment of Baha’i students]



Islamic Republic of Iran

Ministry of Education

Head Office of the Department of Education, Tehran Province

In the Name of God







The applicant is required to answer the questions below with complete honesty

  1. Name –------ Family name ----- Name of father --------

Birth certificate number------- Date of birth ------- declaration number ------

  1. Are your father and mother Baha’is?
  2. Are you a follower of the Baha’i sect?
  3. How many years have you been following this faith?
  4. Do you discuss your faith in class?
  5. Who among your relatives and acquaintances are followers of the Baha’i faith?
  6. Do you agree to withdraw from this faith?
  7. Any additional information that you think it is necessary to provide:


Place for signature -----

[Handwritten note at the bottom of the page] (Mehr 1360, [September/October 1981])