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• Fecha: 2018-01-28

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Islamic Republic Of Iran
Ministry of Science, Research and Technology

Application Form for International Students

Individual Information:
First Name
Surname
Middle name
Father's name
Spouse name
Religion
Nationality 1- 2- 3-

Sex: Male Female

Marital status: Single Married

Number of children(if any)

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 (
Country City University/Institute Dates of Attendance GPA/
Academic Record Major Degree Level
To
(Month/ Year From
(Month/ Year

Please indicate reason for preference Please list preferred fields of study
(in order of preference):
1
2
3

Fluency in languages:

Speaking Writing Reading Language
Poor Fair Good Poor Fair Good Poor Fair Good
Farsi
English

Book and articles you have published:

Date Publisher
Title
1
2
3

Names, Addresses and Telephone numbers of Relatives and friends in Iran. (If there is any)

Address Tel.No. Surname First Name Relationship with Applicant

Please state your reason(s) as to why you wish to study in I.R.IRAN:
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
(Only graduate applicants have to complete this part):

In which field(s) are you interested to conduct research?
…………………………………………………………………………………………………………………………………………………………………………………………………………

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 Degree Relationship University and City Duration of stay in Iran
1

2

3

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 Iran’s Ministry of Science, Research and Technology.

Applicant’s Signature¬¬¬¬¬¬¬¬¬¬¬¬_ Date _

PASSPORT INFORMATION

PERSIAN LATIN DATA
NAME
SURNAME

    DATE OF BIRTH

    PLACE OF BIRTH

    FATHER'S NAME

    NATIONALITY
    PASSPORT NO.

    DATE&PLACE OF ISSUE

    EXPIRY DATE

    OCCUPATION

    PLACE VISA TO BE ISSUED

    DURATION OF STAY IN IRAN

    THE LAST DATE OF ENTIRY TO IRAN