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Individual Information:
First Name
Surname
Middle name
Father's name
Spouse name
Religion
Nationality 1- 2- 3-
Residence Country :
Present address:
No: Street : City: Post/Zip code:
:Country : Telephone number (including country and city code)
E-mail:
Educational Background :)University/College Education and Qualifications (
Degree Level Major /GPA Dates of University/Institute City Country
Academic Attendance
Record From To
(Month/ (Month/
Year Year
Please list preferred fields of study Please indicate reason for preference
(in order of preference):
1
2
3
Fluency in languages:
Language Reading Writing Speaking
Good Fair Poor Good Fair Poor Good Fair Poor
Farsi
English
1
2
3
Names, Addresses and Telephone numbers of Relatives and friends in Iran. (If there is
any)
Relationship with First Surname Tel.No. Address
Applicant Name
.
(Only graduate applicants have to complete this part):
Have you ever been in contact with faculty members of the I.R. Iran University Council?
Is anyone in your family (father, mother, sister, brother, husband, son or daughter)
currently studying or graduated (on scholarship basis) in the Islamic Republic of Iran?
If yes, mention the specifications:
Name Major and Relationship University Duration of
Degree and City stay in Iran
1
Where documents are found to be INVALID, the admission agreement will be revoked.
The completion and submission of this application form does not necessarily guarantee
acceptance of the applicant by the Islamic Republic of Irans Ministry of Science, Research and
.Technology
DATE OF BIRTH
PLACE OF BIRTH
FATHER'S NAME
NATIONALITY
.PASSPORT NO
DATE&PLACE OF ISSUE
EXPIRY DATE
OCCUPATION