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Islamic Republic Of Iran

Ministry of Science, Research and Technology

Application Form for International Students


:Requested study level

Bachelor Master PhD MD Other

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 (
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

Book and articles you have published:


Title Publisher Date

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

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 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 Iran’s Ministry of Science, Research and
.Technology

_________________ Applicant’s Signature_____________________________________________ Date


PASSPORT INFORMATION

DATA LATIN PERSIAN


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

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