Shahrekord University of Medical Sciences (SKUMS)
International Affairs Department

Tracking Code: Date Received: Full Name: Student ID Number: Nationality: Program of Study & Level: Mobile Phone: Email Address: Current Address in Iran: Name of department / staff member:

(Please provide exact date(s), location, persons involved, and all relevant details. Continue on additional pages if necessary.)

I declare that the information provided is true and complete to the best of my knowledge. I understand that submitting false information may result in disciplinary action.

Student’s Signature: Date: Submit Form