Application Form for Phd Applicants

Application Form for PhD Applicants

Please fill out this form and the attached document in block letters. Incomplete form will be rejected.

A) PERSONAL DETAILS:

First Name / ……………………………………………………………………………… / Gender:
☐ Male
☐ Female
Middle Name / ………………………………………………………………………………
Last Name / ……………………………………………………………………………… / Marital Status:
☐ Single
☐ Married
Number of children:
(If married)
Father’s Name / ………………………………………………………………………………
Mother’s Name / ………………………………………………………………………………
Spouse’s Name / ………………………………………………………………………………
Nationality: ………………………………………………… / Religion: ………………………………………………………..
Date of Birth: / Place of Birth:
City: ……………………….…Country:……………………………
N.I.C No: ……………..… / Passport No:……………………………… Date of Issue:
Place Of Issue: ………………………….. Date of Expire:
Present Address: Flat: ………… No: ………….. Street: ……………………………………….. City:…….………………….
Province/State:………………………………………. post/zip Code: …………………………….. Country: …………………..
Telephone No.: …………………………………………………. Mobile No.: ……………………………………………………….
Fax No.: …………………………………………………………….. Email:………………………………………………………………..

B) EDUCATIONAL INFORMATION

1. All schools attended in chronological order:

Degree / Field of study / Starting Date / Graduation Date / Grade Point Average / School/ University / City / Country
High School
Bachelor
Master

2. What is your MSC Thesis Title? …………………………………………..

3. You plan to study in which department(s) and major(s) at IUT?.………………………………………………………

4. Are you studying in any institution at present? ☐ Yes ☐ No

If yes, please complete the following table:

Field of study / Name of institute / Place of the Institute / Level of Education / Starting Date

5. Financial Supports:

☐ Scholarship of institution ☐ Personal Income ☐ Family Support ☐ Own Company ☐ other

- A copy of your proof of Scholarship must be signed and sealed by the embassy or the consulate of the Islamic Republic of Iran

6. Fluency in Language(s):

Reading / Writing / Speaking
Language / Good / Fair / Poor / Good / Fair / Poor / Good / Fair / Poor
Farsi
English
Arabic
Any other Language: 1- 2- 3-

Do you have any language certificate (e.g. TOEFL, IELTS, etc.)? ☐ Yes ☐ No

If yes, please complete the following table: (A copy of your certificate must be attached)

Certificate Title / Grade

7. Books and Articles Published:

Title / Language / Place of publication / Publisher / Year
1
2
3
4

8. Research Interests: Please provide further details of your research interests, together with the name of any academic with whom you may have discussed this

(Please attach any additional sheets if necessary)

9. Name, addresses and telephone numbers of relatives and friends in Iran (If any):

Name / Relationship / Telephone No. / Address

I …………………………… declare to the best of my knowledge all particulars supplied by me are correct and complete and I am aware that any false statement will lead to my application being rejected or the annulment of an admission already granted.

Applicant’s Signature……………………………… Date: Day………… Month……………..Year……………