[Translator’s notes appear in square brackets]

[Personal information has been redacted.]


[The questionnaire form for information concerning the volunteers for one-year teacher training classes related to year 1342 (1963)]


In reply to number ----- and subject ---- please refer.



Information concerning the volunteers for one-year teacher training classes


  1. Name …–Surname
  2. Birth certificate number
  3. Place of issue
  4. Date and place of birth
  5. In which senior high school did you complete grade six [year 12]?
  6. Your field of diploma [year 12]
  7. Date of graduation
  8. Name and occupation of father
  9. Name and occupation of mother
  10. Do you have a spouse?
  11. If you do, provide the name and occupation of your spouse.
  12. Number of children
  13. In which university have you been studying?
  14. What is your religion?
  15. Who is the last prophet of God?
  16. Which is the last heavenly book of God?
  17. In the absence of the Imam of the Period (Peace be upon him), Shias follow the more learned religious authority. What do you do?
  18. Complete home address and house number
  19. Phone number
  20. Sample of signature
  21. If the home address or any other details in this declaration change, I am committed to immediately inform the institute office.