[Translator’s notes appear in square brackets]

[Personal information has been redacted.]


In the Name of God

Ministry of Science, Research and Technology

National Educational Assessment and Evaluation Organization

Office of the Central Council for Student Placement


Form Number 2


Student’s Written Undertaking

Important note: Completing this form is essential for the respected student’s placement process.

File number: ----- Student’s examination field ----- Year of examination: -----

I, -----; son/daughter of -----; born on 13--/----/----; with National Code: -----; issued at -----; based on Form Number 1, I introduced myself as Baha’i and born in a Baha’i family. I participated in the university entrance examinations; the results of my chosen field have been announced as ----.  Therefore, I undertake to follow all educational rules and regulations, and abstain from participating in any administrative or sectarian activities, whether teaching or in cooperation with the debunked committees of Baha’ism. I will prefer obedience to the rules and regulations of the Regime over obedience to statements, instructions and orders of the central institution of the sect, located in the occupied territories of Palestine, called the Universal House of Justice, or its agents.

Signature ------- Fingerprint ------- Date -------


I, -----; son/daughter of -----; born on 13--/----/----; with National Code: -----; issued at -----; am absolutely obedient to the Universal House of Justice as an infallible authority and do not accept the above statement.

Signature ------- Fingerprint ------- Date -------