[Translator’s notes appear in square brackets]

[Personal information has been redacted.]


In the Name of God

Form to Register Information About Students of Other Religions

Student’s Personal Information:

Name: ----- Family Name: ----- Father’s Name: ----- Date of Birth: ----- Place of Birth: -----

Birth Certificate Number: ----- National ID Number: ----- Birth Certificate Place of Issue: -----

Education Field: ----- Grade: ----- Name of Institution: ----- Address and Phone of Institution: -----

Religion: Christian ----- Jewish ----- Zoroastrian ----- Other Sect (with its name) -----

Grade Average of Previous School Year: ----- Participation in extracurricular activities: -----

Cooperation with Islamic Organization, Basij and -----

Family Members’ information:

[Table to record Name, Family Name, Age, Education, Occupation and Place of Work of parents and all brothers and sisters chronologically]

Please complete the above form carefully and legibly.

Date completed: -----

With thanks