Appendix B: Study Abroad Form Requiring a Guardian’s Consent for Female University Students
[Translated by Human Rights Watch from the Arabic original]
The Kingdom of Saudi Arabia
Ministry of Higher Education
Agency of Cultural Relations
General Directorate of Research
Permission Request Form to Study Abroad at Personal Expense
Personal Information:
1. Name (at least to the fourth degree) in Arabic: ………………………………………………
Name in English (as appears in passport): …………………………………………………………
2. Date of Birth: ………../……../………………… Place of Birth:
3. Marital Status Single ˜ Married ˜
4. Number of Civil Registry: Issued on: ……./……../………Issued in: ……. /……../………
5. Passport: Issued on: ………../……../………………… Place of Issue:
6. Permanent Address: PO Box: Zip Code: City:
Phone Number: Fax Number: Email Address:
Educational History:
1. High School Degree ………………………………………………………………………
Percentage Date [of graduation] Issued by:
2. Last degree issued: Issued by: Date: ………../……../…………………
3. Did you study at a university in Saudi Arabia or elsewhere?
No ˜ Yes ˜ (Please provide the following information)
Name of University: Academic Year:
University number/ code: Number of hours completed:
4. Are you a government employee? No ˜ Yes ˜ (Mention the division)
5. Desired academic level:
˜ Diploma ˜ Baccalaureate ˜ Masters ˜ Fellowship ˜ Doctorate
6. Specialty: 7. Enrollment: ˜ Full-time ˜ Part-time
8. Name of university: City: Governorate/ District: State:
Give the names of three references that you know well and their addresses:
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Full Name |
Address |
City |
Phone Number(s) |
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1. |
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2. |
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3. |
I hereby certify that the above provided information is accurate.
The applicant must read carefully the following consent forms and sign the relevant ones:
I, student [Name] -------------------------------------------------- hereby certify that:
I am NOT an employee and do NOT work in any government division.
Signature:
I commit to not leave my educational institution before paying back all my financial obligations. I also commit to pay back any fees that would cause financial claims after my departure. I commit to provide the cultural attaché office at least an annual report about the progression of my education.
Signature:
Certification applicable to students of Medicine
I acknowledge that I will take an exam upon my return with the degree from the Saudi Committee of Medical Specialties, the results of which will determine whether I will be authorized to practice.
I commit to consult the bylaws and the guidelines of the practice of Medicine in Saudi Arabia and abide by them.
Signature:
I, guardian of the [female] student ……………………………………………… commit to accompanying her during her entire schooling.
Name: Relationship:
Signature:
Appendix C: Surgical Procedure Form Requiring a Guardian’s Consent
