APPLICATION FOR ADMISSION
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- Information
1 Title:
Select from list
Mr
Mrs.
Miss.
Ms.
Other
2 Last Name:
3 First Name:
4 Middle Name:
5 Gender:
Select from list
Male
Female
6 ID NO: Accept unique answers
7 Field of study requested:
Select from list
Undergraduate
Graduate
Medicine
Pharmacy
Other
8 Date of Birth:
Gregorian date:
9 Country of Birth:
10 City of Birth:
11 Country of Residency:
12 Marital Status:
Select from list
Married
Single
Divorced
Widowed
Separated
- Contact Details
13 Mailing Address:
14 Postal code:
15 Town/City:
16 State:
17 Country:
18 Cell phone:
19 Work Dial:
20 Home Dial:
21 Email address:
22 Work/Home Fax:
23 Program name:
- Academic qualification
24 Please add your study history, completed or attempted after secondary school, and relevant to this course application. Provide as much detail as possible so that we can give your application the consideration it deserves.
Comments. index. Course Name. Degree Of Study. Country. Institution Name. Last year of Study. Completed(yes). .
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25 School:
26 Degree:
Select from list
B.Sc
M.Sc.
M.D.
Ph.D.
27 Please attach your C.V. in support of the details provided.
Please attach the requested file to the form.
28 Have you ever been refused entry to, expelled or excluded from another academic institution? If “Yes”, provide the details :
29 Do you owe fees to another academic institution? If “Yes”, provide the details :
- Work History
30 Please list your work history (beginning with your most recent). Attach a separate sheet if the space below is insufficient. Provide as much detail as possible so that we can give your application the consideration it deserves.
Comments. index. Position or Job title. Start date. End date. Full time or Part time. Employer. Industry.
index. . . . . . . .
1. . . . . . . .
2. . . . . . . .
3. . . . . . . .
4. . . . . . . .
31 Please attach your resume in support of the details provided:
Please attach the requested file to the form.
- Scholarship And Details
32 Name of a person/organization expected to pay your fees (e.g.: the name of an Employer, Sponsor or Yourself):
33 Do you wish to apply for financial assistance?
 Yes
 No
- English Proficiency
34 Was English the language of instruction at your school/college/university?
 Yes
 No
35 English Language proficiency test score:
. . . . .
- Declaration
- I have fulfilled all requirements required to be eligible for consideration.
- To the best of my knowledge, the information given in this application is correct and complete.;
- I understand that submitting false or misleading information may result in any offer of a place withdrawn at any stage, including after a course has commenced.
- I understand that the University reserves the right to vary or reverse any decision made on the basis of incorrect or incomplete information.
- The University is under no obligation to consider an application submitted after the due date.
- I acknowledge and accept the full enrolment terms and conditions that govern this application form.
- I understand that Iran University of Medical Sciences collects, stores, and uses personal information in accordance with the University's Privacy Policy.