Apply to Gonabad UMS
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(*) indicates required fields
- Application For Admission
1 Title
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Mr
Mrs.
Miss.
Ms.
2 Last Name:
3 First Name:
4 Middle Name:
5 Gender:
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Male
Female
6 ID NO:
7 Field of study requested :
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Medicine (MD)
Intensive Care Nursing (MSc)
Nursing Education (MSc)
Community Health Nursing (MSC)
Special Care Nursing (Msc)
Health Education and Health promotion (MSc)
Environmental Health (MSc)
Midwifery (MSc)
Midwifery (MSc in Reproductive Health)
Midwifery (BSc)
Nursing (BSc)
Anesthesia (BSC)
Operating Room (BSc)
Public Health (BSc)
Environmental Health (BSc)
Occupational Health (BSc)
Emergency Medial Services (ASc)
Oral Health Technician (ASc)
Laboratory Sciences (BSc)
Radialogy (BSc)
Nutrition Sciences (BSc)
Library and Medical Information(BSc)
8 Date of Birth:
Gregorian date:
9 Country of Birth:
10 City of Birth:
11 Country of Residency:
12 Marital Status:
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Married
Single
Divorced
Windowed
13 Religion:
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Islam-Shia
Islam-Sunni
Christian
Jew
Others
- Contact Details
14 Mailing Address :
15 Postal Code :
16 Town/City :
17 State :
18 Country :
19 Cell Phone :
20 Work Dial :
21 Home Dial :
22 E-mail Address :
23 Work/Home Fax :
24 Program Name :
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Degree Program
Non-degree Program
25 School :
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Medicine
Nursing and Midwifery
Health
Allied Medical Sciences
26 Degree :
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MD
MSc
BSc
ASc
- Academic qualification & Work History
27 Please attach the following:
1- your C.V. (resume) 
2- a copy of the first page of your passport
3- copies of your high school diplomas and the related report cards (transcripts).
Please attach the requested file to the form.
- 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- I understand that submitting false or misleading information may result in any offer of a place withdrawn at any stage, including after a course has commenced.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 Gonabad University of Medical Sciences collects, stores, and uses personal information in accordance with the University's Privacy Policy.