Yazd University

Applica on Form of Interna onal StudentsAddress: Office of Interna onal Students, Yazd University

University Blvd., Safayieh, 8915818411, IranWeb: admission.yazd.ac.ir/ Email: apply@yazd.ac.ir

Tel: +98-35-3123-3133 Tel/Fax: +98-35-3820-0149, +98-35-3820-9822

Applicant’sPhoto (click)

No ce: Please fill the formusing AdobeAcrobat Reader. Applica onNo. (do not fill)Requested study level: Bachelor Master PhD Visit (short term)Requested Field of Study: 1) 2) 3)Apply for scholarship: Yes No

A) Personal Informa on

First Name: Middle Name: Last Name:Father’s Name: Mother’s Name:Date of Birth: Day Month Year Place of Birth: City: Country:Gender: Male Female Marital Status: Single MarriedReligion: Spouse’s Name (if married): No. of Children(if any) :Passport No.: Date of Expire:

Day Month YearDate of Issue:

Day Month YearPlace of Issue:

Na onali es: 1. 2. 3.Telephone No.:

Postal Address Fax No.:(Current) Cell phone No.:

Email Address:

B) Educa onal Informa onDegree Field of Study Dura on GPA School/University City Country

Start EndHigh SchoolBachelorMasterPhD

C) Fluency in Language(s)Language Na ve Language Reading Wri ng Speaking

Good Fair Poor Good Fair Poor Good Fair PoorPersian Yes NoEnglish Yes NoArabic Yes No

Others (men on) Yes No

Yes No

D) Referees (if any)Name Posi on Ins tute Rela onship Email Address

E) Publica ons (books, ar cles, theses, etc)Title Journal/Publisher Year Paper Book Others

Journal Conference

F) Informa on of rela ves or friends in Iran (if any)Name Rela onship Telephone No. Address

G) Please state reason as to why you wish to study in Yazd University:

H) Declara on

I declare that to the best of my knowledge all par culars supplied by me arecorrect and complete and I am aware that any false statement will lead to my applica on being rejected or tothe annulment of an admission already granted.

Applicant’s Signature Date PlaceDay Month Year City/Country

Signature (click)

AF20170607