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25/08/2019
 
This form should be completed if you wish to apply for admission as a student in University of Social Welfare & Rehabilitation

A: All questions must be completed

A(1) Personal details Section

First Name : *
Last Name :(same as on your passport ) *
Last Name (previous if any)
Date of Birth
*

Gender

Male Female

Title *
Nationality and residence
Country of birth: *
Nationality: *
Any second nationality:
Do you require a visa to study in Iran? Yes No

A(2) Contact Information 1

Mailing Address: *
Email *
Telephone *
A(3) Program of Study1
Date you wish to start (tick one only):
First semester(September 31th)
Second semester (January 31th)
Details of your program of study
Course *
Department *
A(4) Current Study

I am not currently studying – go to A(5)

I am currently studying as follows:
Name of the University(include country)
Subject(include Faculty/Department)
Degree
Date Started

Date to be Obtained

A(5) Previous degree-level study (most recent first)
Name of the University - include country *
Subject(include Faculty/Department) *
Degree *

If you have worked on a research project, either for your first degree or subsequently,please describe your work .

*
A(6) Prizes and distinctions obtained (list only the most important)

Name and Date of award

Reason for award
A(7) If you have previously applied for admission to USWR, give details here
Degree
Program of study/research
Department
A(8) Employment History
Are you currently employed?

Yes No

Institute/organization
Post held  
A(9) Names and addresses of your academic referees
First academic referee *
Second academic referee *

A(10) Summary details of research proposal or reason for applying for the course

*
A(11) Papers
Title *
Journal/year *
A(12) Additional information in support of your application

Please write down any additional information