[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Questionnaire form to learn about incoming students when enrolling in schools. In this questionnaire, there is a question related to the religious status of the student]

 

In the Name of God

“Lord, help me to educate my children well” Imam Sajjad (AS)

 

Questionnaire to learn about incoming students at the time of registration

 

A: Profile of the students and his/her parents:

Name and last name of the student: ----- Name of father: ----- Birth Certificate number: ----- Birth date: 13-----

Home address and telephone number: -----

Father’s occupation: ----- Father’s education: ----- Father’s work address and telephone number: -----

Mother’s occupation: ----- Mother’s education: ----- Mother’s work address and telephone number: ---

- Which parent is deceased?

- It should be mentioned if the stepfather or stepmother is the guardian of the student

- If the student is from the family of martyrs and those who have sacrificed themselves, the status of self-sacrifice should be specified

- What order of birth does the student have [in the family] and how many siblings does he/she have?

- It should be mentioned if [the student] is covered by Imam Khomeini’s Relief Committee (RAH), welfare or -----

- The appearance of the student should be described in simple terms

- The religious status of the student should be described.

- Other issues related to the profile of the student:

Registration Headquarters of Kermanshah’s District 3 [Department of] Education