JAHROM UNIVERSITY OF MEDICAL SCIENCES
SCHOOL OF MEDICINE
APPLICATION FOR ADMISSION TO 2020 MEDICAL PROGRAM
1. ENROLMENT NUMBER (to be assigned by the admission office of JUMS)
2. Full Name of the Candidate (Type in Capital Letter)………………………………………
- as appeared in his/her passport
3. Name of Father / Guardian / Husband
Date Month Year Male Female
4. Date of Birth 5. Sex
- as per Christian era
6. Nationality……………….. 7. Community……………….. 8. Religion…………………..
Yes No
9. Are you physically challenged? 10. Mother Tongue………………….
10. Postal Address for Communication (Type in Capital Letters)
Name: ……………………………………… Address: ………………………………………
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Postal Code:
11. Phone (Res): …………… 12. Reg. Mobile: ……………… Affix
-area code to be included Recent Passport Size
13. E-mail: …………………………………………………….. Photo
14. Where do you want to apply for Iranian visa: ……………..
Place:
Date: Signature of the Candidate:
JAHROM UNIVERSITY OF MEDICAL SCIENCES
SCHOOL OF MEDICINE
DETAILS OF EDUCATION UNDERGONE BY THE CANDIDATE
Full Name of the Candidate (Type in Capital Letter)………………………………………
- as appeared in his/her passport
1. Pattern of Education: 12 11 + 1 10 + 2
Others (Specify ………………)
2. Marking Pattern: 0-20 0-100 Others (Specify …………)
3. Details of the Last Three Years of Secondary School Education:
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Exams Passed
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Country / City
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Name of the Institution
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Reg. No.
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Date
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Subject
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Grade Obtained
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S.S.L.C./12th Std.
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S.S.L.C./11th Std.
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S.S.L.C./10th Std.
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4. Details of Higher Education, If Any:
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Exams Passed
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Country / City
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Name of the Institution
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Reg. No.
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Date
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Subject
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Grade Obtained
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Advanced Diploma
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Bachelor Degree
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Master Degree
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M.Phil.
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PhD
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Place: Date: Signature of the Candidate:
JAHROM UNIVERSITY OF MEDICAL SCIENCES
SCHOOL OF MEDICINE
DOCUMENTS TO BE ENCLOSED BY THE CANDIDATE
5. Provide copy for the above stated documents.
6. Get the stated documents attested by an official of your country.
7. Include a copy of your passport.
8. E-mail and contact No. to be used in emergencies.
9. Type name, address, phone No. and e-mail of the institutions in which the candidate has undergone education:
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10. Medium of Instruction Opted Persian English
11. Applicants have to download the forms; Type the required information and mail them to the e-mail address of the Office of International Affairs, JUMS: ia@jums.ac.ir.
Place:
Date: Signature of the Candidate:
* Provisional admission is issued for the candidates that are found eligible for medical program. They will receive a soft copy of provisional admission at their e-mail accounts. After getting visa, their admission will be finalized.
JAHROM UNIVERSITY OF MEDICAL SCIENCES
SCHOOL OF MEDICINE
ADDRESS SLIP
TYPE YOUR ADDRESS IN THE FOLLOWING SLIPS. USE CAPITAL LETTERS.
JAHROM UNIVERSITY OF MEDICAL SCIENCES