[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[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]

 

[Emblem]

Islamic Republic of Iran

Ministry of Education

Head Office of Education of Tehran

 

In the Name of God

 

Office

Date

Number

Enclosure

 

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 -----