[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

In the Name of God

From: Security Office of the Department of Education, District One, Shiraz

To: All educational units in cities and villages – Siyakh Darengun Representatives

[Stamp] Confidential

Number: 1833/17/M

Date: 30 Aban 1385 [21 November 2006]

 

With greetings and salutation,

Respectfully, as a follow-up to Circular No. 1067/17/M, [dated] 15 Mehr 1385 [7 October 2006], the form below is directed to you to record data related to students of religious minorities and the perverse Baha’i sect.  [You are] requested to return the form to the Security Office once it is completed. /H

With prayers,

Security Office of the Department of Education in District One of Shiraz

[Signature]

 

Registration Form to record student data in Shiraz District One, Area One for academic year 1385-1386 [2006-2007]

1- Personal information of the student

Name: ---- Last Name: ----- Father’s Name: -----

Date of Birth: ----- Identification Card Number: ----- Place of issue: -----

Nickname: ----- Degree: ----- Name of school: -----

Class: ----- Branch: ----

Religion: Christian ----- Jewish ----- Zoroastrian ----- perverse Baha’i sect -----

2 - Information of the family members:

Name and surname - Father: ----- Mother: ----- Brothers and sisters in order of age: first - second ... up to sixth -----

Age - Father: ----- Mother: ----- Brothers and sisters in order of age: first ---- second ----- third ----- fourth ----- fifth ----- sixth -----

Education - Father: ----- Mother: ----- Brothers and sisters in order of age: first ---- second ----- third ----- fourth ----- fifth ----- sixth -----

Occupation - Father: ----- Mother: ----- Brothers and sisters in order of age: first ---- second ----- third ----- fourth ----- fifth ----- sixth -----

Place of Occupation - Father: ----- Mother: ----- Brothers and sisters in order of age: first ---- second ----- third ----- fourth ----- fifth ----- sixth -----

Should parents be self-employed, their business must be described in full.

3- Place of studies - Last year: ----- City: ----- Region: ----- District: -----

4- Phone number in case of emergency: -----

Telephone number: ---- Telephone owner’s name: ----- Relationship with you: -----

5- In case of death or separation of parents, the date must be recorded.

6- If you use school bus service:

Driver Name: ---- Service Number: ----

7- In case of employment of parents after retirement, state the exact address of their workplace.

8- The parents’ work phone number and their mobile number:

9- Home address: -----

Home Telephone Number: ----- Postal Code: ----- Clear map to your house: -----

 

Name and surname of the school principal: ----- Signature of principal and stamp of the school -----