AI English Translation, Pages 1-25
Iraqi Ministry of Education
School Directorate: ⟦illegible⟧
Number - / /
Date 1 / 5 / 196
Shamash Preparatory School
Baghdad
Alwiyah Al-Jadeeda
Telephone 91693
No: Sh / 37 / 62
Date: 10 / 5 / 1962
Directorate of Education, Baghdad Province / Al-Rusafa
Greetings.
Enclosed are the two documents numbered Sh/727 and Sh/728 dated 10 / 5 / 1962
belonging to Akram Habib Shalom for certification.
Please accept our highest respect.
Isaac Cohen
Acting Director
That
From a school
In the round
With this
1- Accepted
Original
2- Documents
The party
⟦Recruitment Directorate⟧
3- Classes
4- Lessons
His behavior and regularity
Date of
Assistant
Clerk of the
Acting School Principal
Isaac Cohen
Iraqi Ministry of Education
School Directorate: ⟦Shamash⟧ ⟦...⟧
Number - ⟦...⟧
Date 10 / 5 / 1960
Examination Number 1445
To - Ministry of Defense
Ibrahim Shalom Saraf, whose photograph is attached above, is one of the students of the Fifth Preparatory Grade (Scientific)
from our school who entered the (General) examination for the year 1954 / 1955 and his result was (Pass)
in the (First) session and he obtained the grades listed on the back. Based on his request, we provided him
with this document.
1- Admitted under Transfer Certificate No. 222 dated 29 / 8 / 1952
issued by Frank Iny Intermediate School in Baghdad
2- Documents previously provided to him.
Entity addressed in the document | Number | Date | Document Type
Directorate of General Recruitment | 373 | 29 / 7 / 1955 | Preparatory
Missions | 70 | 20 / 4 / 1956 |
General Recruitment | 147 | 20 / 9 / 1956 |
Missions | 727 | 10 / 5 / 1960 |
3- Grades in which he failed, number of failing years, and reason for failure (illness or other): Did not fail
4- Subjects in which he had to re-sit.
His behavior and attendance regularity.
Date of leaving school June 1955
Non-forfeiture ID number 2192 on 7 / 7 / 1952
Assistant
School Clerk
Acting School Principal
Iraqi Ministry of Education:
School Directorate :: ⟦illegible⟧
Number -: Sh / 217
Date: 10 / 5 / 1960
Examination Number: 1445
To - Directorate of Missions and General Retirement
That Akram Fahim Shalom, whose photograph is attached above, is one
of our school students who entered the (General) examination for the year 1954 / 1955 and was
in the (First) session and obtained the grades listed on the back, and based on his request
this document [was issued].
1- Admitted according to Transfer Certificate No. 222 dated 9 / 9 / 1952
issued by Frank Iny Intermediate School in Baghdad
2- Documents previously provided to him.
Entity to which the document is addressed | Number | Date | Type of Document
General Recruitment Directorate | 242 | 29 / 7 / 55 | School
" Missions | 70 | 20 / 4 / 56 |
" Recruitment | 147 | 10 / 9 / 56 |
3- Classes in which he failed, number of years of failure, and reason for failure (illness or other) Did not fail
4- Subjects in which he completed [re-examined].
His conduct and regularity of attendance.
Date of leaving school June 1955
Non-revocation identity number 2192 on 7 / 7 / 1952
Assistant
School Clerk
⟦signature⟧
Akram Fahim
Acting School Principal
Iraqi Ministry of Education
School Directorate: ⟦illegible⟧
Number: Sh / ⟦illegible⟧
Date: 10 / 5 / 1960
Examination Number: 1445
To - Directorate of Missions and Equivalency of Certificates
Akram Fahim Shalom, whose photograph is attached above, is one
of our school students who entered the (General) examination for the year 1954 / 1955 and was
in the (First) session and obtained the grades listed on the back, and based on his request
this document [was issued].
1- He was admitted according to the transfer certificate numbered 222 and dated 29 / 9 / 1952
issued by Frank Iny Intermediate School in Baghdad
2- Documents previously provided to him.
Entity to which the document is addressed | Number | Date | Type of Document
Directorate of General Recruitment | 242 | 29 / 7 / 55 |
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
⟦line⟧
Shamash Secondary School
Baghdad
Telephone 91693
⟦line⟧
Subject:
Number: SH/148/56
Date: 9/10/1956
Directorate of Education of Baghdad Province / Center
Greetings.
We attach herewith the document numbered SH/147/56 dated 9/10/1956 belonging to
Akram Habib Shalom. Please kindly certify it.
Please accept our highest respect.
⟦signature⟧
Isaac Cohen
Acting Director
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
Shamash Secondary School
Baghdad
Telephone 91693
No:
Number:
Date: 29th July, 1955.
Date:
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
Shamash Secondary School
Baghdad
Telephone 91693
Subject:
Number: Sh/148/56
Date: 10/9/1956
Directorate of Education of Baghdad Province / Center
Greetings.
We attach herewith the document numbered Sh/147/56 and dated 10/9/1956 belonging to
Akram Habib Shalom. Please kindly certify it.
Please accept our highest respect.
⟦signature⟧
Isaac Cohen
Acting Principal
a student
1955, he
on for
his class-
jects are
mark in
50%.
passing mark
ubjects is
ssfully in
e of Education
in Arabic at
in Physics
gent and of
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
⟦line⟧
Shamash Secondary School
Baghdad
Telephone 91693
⟦line⟧
Subject: ⟦line⟧
Number Sh/: 56/⟦...⟧
Date: 10 / 9 / 1956
General Directorate of Recruitment.
Akram Habib Shalom, whose photograph is attached above, was one of the students of this school who attended
it and graduated from it after participating in the general examination for secondary studies for the academic year
1954 / 1955 and passed it in the first session, and his examination number was 1445.
The aforementioned person was not provided with any transfer certificate to any other school, and he was previously provided with a document
addressed to Robert College in Turkey, numbered Sh/340 / 55 and dated 29 / 7 / 1955,
as he was also previously provided with a document numbered Sh/343 / 55 and dated 29 / 7 / 1955 addressed to the Directorate
of Education of Baghdad Province and referred to the General Directorate of Recruitment, as well as a document numbered Sh/69 / 56
and dated 30 / 4 / 1956 addressed to the Directorate of Missions and Equivalency of Certificates in the Ministry
of Education.
Non-revocation identity number 2192 and its date 7 / 2 / 1952
⟦signature⟧
Isaac Cohen
Acting Director
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
⟦line⟧
Shamash Secondary School
Baghdad
Telephone 91693
⟦line⟧
Subject:
Number: SH / 70 / 56
Date: 30 / 4 / 1956
Directorate of Education of Baghdad Province / Center
Greetings,
We attach herewith the school document numbered SH/69/56 and dated 30 / 4 / 956
belonging to Akram Habib Shalom. Please kindly certify it.
Please accept our highest respect.
⟦signature⟧
Abdullah Obadia
Principal
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
⟦line⟧
Shamash Secondary School
Baghdad
Telephone 91693
⟦line⟧
No:
Date: 29th July, 1955.
Number:
Date:
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
⟦line⟧
Shamash Secondary School
Baghdad
Telephone 91693
⟦line⟧
Subject:
Number: SH / 69 / 56
Date: 30 / 4 / 1956
To -
Directorate of Missions and Equivalency of Certificates
in the Ministry of Education
Akram Habib Shalom, whose photograph is affixed above, was one of the students attending the
Fifth Preparatory Class of this school in the past year 1954 / 1955
and he participated in the General Examination for Preparatory Studies for the mentioned year and passed it
in the first session, and his examination number was 1445.
The aforementioned person was not provided with any transfer certificate to any other school during his studies at
this school.
The aforementioned person was provided with the following documents.
1 - A graduation certificate from preparatory studies addressed to the Directorate of Education of Baghdad Province
numbered SH / 321 / 55 and dated 15 / 7 / 955
2 - A school certificate to Robert College numbered SH / 3409 / 55 and dated 29 / 7 / 955
3 - A school certificate addressed to the Directorate of Education of Baghdad Province numbered SH / 343 / 55
and dated 29 / 7 / 955 for referral to the General Recruitment Directorate.
⟦signature⟧
Abdullah Ovadia
The Principal
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
Shamash Secondary School
Baghdad
Telephone 91693
No: ⟦line⟧
Number: ⟦line⟧
Date: 29th July, 1955.
Date: ⟦line⟧
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
Shamash Secondary School
Baghdad
Telephone 91693
No:
Date: 29th July, 1955.
Number:
Date:
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
Shamash Secondary School
Baghdad
Telephone 91693
Subject:
Number: Sh/66/56
Date: 30/4/1956
To - Directorate of Missions and Equivalency of Certificates
in the Ministry of Education
Akram Habib Shalom Al-Shabt ⟦illegible⟧ above was one of the regular students in
the fifth secondary grade of this school in the past year 1954 / 1955
and he participated in the general examination for secondary studies for the mentioned year and passed it
in the first session and his examination number was 1445.
The aforementioned person was not provided with any transfer certificate to any other school during his studies in
this school.
The aforementioned person was provided with the following documents.
1 - A graduation certificate from secondary studies addressed to the Directorate of Education of Baghdad Province
numbered Sh/321 and dated 15/7/955
2 - A school certificate to Robert College numbered Sh/340 and dated 29/7/955
3 - A school certificate addressed to the Directorate of Education of Baghdad Province numbered Sh / 343 / 55
and dated 29/7/955 for referral to the General Directorate of Recruitment.
Abdullah Obeidia
Principal
s a student
, 1955, he
ion for
his class-
bjects are
mark in
50%.
passing mark
subjects is
essfully in
e of Education
in Arabic at
in Physics
gent and o
SHAMASH SECONDARY SCHOOL
BAGHDAD
Tel. No. 91693
⟦line⟧
Shamash Secondary School
Baghdad
Telephone 91693
⟦line⟧
No:
Number:
Date: 29th July, 1955.
Date:
The Registrar,
Robert College,
Bebek 8, Istambul, Turkey.
Dear Sir,
I, hereby, certify that Mr. Akram Haim Shalom was a student
in this School for the last two years. In June, this year, 1955, he
sat successfully for the Iraq State Baccalaureate Examination for
Secondary Education winning 9th place among 18 students of his class-
mates. His marks in this Examination for the different subjects are
as follows :
SUBJECT | MARK %
Arabic ⟦line⟧ | 64
English ⟦line⟧ | 79
Solid Geometry ⟦line⟧ | 66
Biology ⟦line⟧ | 70
Algebra & Trigonometry ⟦line⟧ | 94
Chemistry ⟦line⟧ | 67
Physics ⟦line⟧ | 59
Total out of (700) | 499
Note: Minimum passing mark in
each subject is 50%.
Minimum average passing mark
for the whole subjects is
60%.
⟦illegible⟧ June
In addition to the above, Mr. A.H.Shalom sat successfully in
November 1954, for the London University General Certificate of Education
Examinations in Pure Mathematics at the <del>ordinary</del> level and in Arabic at
the advanced level. He also sat in June, this year, 1955, in Physics
at the ordinary level, the result of which is not out yet.
to be
While in my School, Mr. Akram proved himself diligent and of
good character.
Sincerely yours,
⟦signature⟧
Abdullah S. Obadiah
Principal
⟦circular stamp with Arabic and English text: SHAMASH SCHOOL BAGHDAD⟧
FRANK INY SCHOOL
INTERMEDIATE & PRIMARY
Baghdad
Telephone No. 91693
Frank Iny School
Intermediate and Primary
Baghdad
Shamash Secondary School
BAGHDAD
Tel. No. 6028
Shamash Secondary School
Baghdad
Telephone 6028
Number: 5/14/10
Date: 29/7/1955
Shamash Preparatory School
Baghdad
Telephone 6028 - 91693
Number: Kh/14/55
Date: 29/7/1955
Graduation Certificate
To the Directorate of Education of Baghdad Province
Akram Rahim Shalom, whose photograph is attached above, participated in the
General Examination for Preparatory Studies (Scientific Branch) for the year 954 - 955 and passed
it, and for this reason we have provided him with this certificate because he completed his secondary studies
Please refer this to the
General Recruitment Directorate
Note that his examination number is 1445
Arabic Language | 64
English Language | 49
Solid Geometry | 86
Zoology and Botany | 70
Algebra and Trigonometry | 84
Chemistry | 87
Physics | 59
Total | 499
Abdullah Shubira
Director
Headmaster.
1445
FRANK INY SCHOOL
INTERMEDIATE & PRIMARY
Baghdad
Telephone No. 91693
Frank Iny School
Intermediate and Primary
Baghdad
Shamash Secondary School
BAGHDAD
Tel. No. 6028
Shamash Secondary School
Baghdad
Telephone 6028
No.:
Number :: 14/55
Date ::
Date :: 29 / 11 / 1955
To,:
To: Robert College (Turkey)
This is to certify that ⟦line⟧ has passed the Iraqi Government Secondary Schools Examination (Scientific Section) held in Baghdad in June 19 ⟦line⟧ and obtained the following marks :-
The student Akram Halim has passed the General Examination for Preparatory Studies (Scientific Branch) for the year 1954/1955 and completed his secondary studies, and below is a statement of his marks :-
Arabic Language | Sixty-four | 64 | Arabic Language
English Language | Seventy-nine | 79 | English Language
Solid Geometry | Sixty-six | 66 | Solid Geometry
Biology | Seventy | 70 | Zoology and Botany
Algebra & Trigonometry | Ninety-four | 94 | Algebra and Trigonometry
Chemistry | Sixty-seven | 67 | Chemistry
Physics | Fifty-nine | 59 | Physics
Total | Four hundred and ninety-nine | 499 | Total
During his study in our school, he has shown himself to be ⟦line⟧ and of ⟦line⟧ character
During his time at the school, he was among the diligent students in their lessons and of good conduct and character.
Yours faithfully.
Director Abdullah Koubaya
Headmaster.
Note that he is a graduate of the examination
1945
FRANK INY SCHOOL
INTERMEDIATE & PRIMARY
Baghdad
Telephone No. 91693
Frank Iny School
Intermediate and Primary
Baghdad
Telephone Number 91693
⟦Shamash⟧ School
BAGHDAD
Tel. No. 6028
Shamash Secondary School
Baghdad
Telephone 6028
No.: 55/227
Number: 55/227
Date: 10/12/1955
Date: 10/12/1955
To:
To:
This is to certify that ⟦line⟧
That ⟦the student Akram⟧ has ⟦line⟧
has passed the Iraqi Government Secondary Schools Examination (Scientific Section) held in Baghdad in June 19 ⟦line⟧ and obtained the following marks :-
passed the general examination for preparatory studies (Scientific Branch) for the year 19 / 19 and completed his secondary studies, and the following is a statement of his marks:-
Arabic Language ⟦line⟧ Arabic Language
English Language ⟦line⟧ English Language
Solid Geometry ⟦line⟧ Solid Geometry
Biology ⟦line⟧ Zoology and Botany
Algebra & Trigonometry ⟦line⟧ Algebra and Trigonometry
Chemistry ⟦line⟧ Chemistry
Physics ⟦line⟧ Physics
Total ⟦line⟧ Total
During his study in our school, he has shown himself to be ⟦line⟧ and of ⟦line⟧ character.
During his attendance at the school, he was among the students ⟦line⟧ in their lessons and of good conduct and character.
Yours faithfully.
Director
⟦signature⟧
Headmaster.
FRANK INY SCHOOL
INTERMEDIATE & PRIMARY
Baghdad
Telephone No. 91693
Frank Iny School
Intermediate and Primary
Baghdad
Telephone Number 91693
No.: ⟦line⟧
Number: ⟦line⟧
Date: ⟦line⟧
Date: 11/4/1953
Baghdad / 4 / 11 / 1953
To /
The Respected Administration of Frank Iny School.
Greetings and respect.
Our son Akram Habib has previously committed acts that disrupted the order in the school,
which had the worst impact on us. Therefore, we can only
offer our apologies to the school administration and we pledge that he will not, in the future,
engage in any behavior that does not please you, and that he will comply with all orders issued by
the administration to him during his attendance at the school.
Please accept our highest respect.
Student's Guardian
⟦signature⟧
Has ⟦...⟧
23 / 10 / ⟦...⟧
And in view of ⟦...⟧
credit and ⟦...⟧
ordered him with a pledge ⟦...⟧
And indeed ⟦...⟧
behavior towards ⟦...⟧
does not perform acts ⟦...⟧
to all orders ⟦...⟧
And upon th ⟦...⟧
the moth ⟦...⟧
I am the student Salim Shaoul from the fourth preparatory grade from the school of
Shamash, I pledge to persevere in my lessons in the mentioned school with all regularity
and to obey all orders and instructions issued by the administration to maintain order and to respect
all procedures decided by the school administration in educational and disciplinary matters without
any objection whatsoever, and the school administration has the full right to apply the punishments it deems appropriate
against me, including warnings, notices, temporary expulsion, and deprivation from the seasonal or final exam, or
permanent expulsion or the like, in the event of any violation by me, whether individually or collectively with
other students.
Baghdad on October 4, 1953
Student's signature ⟦Salim Shaoul⟧
I, Hayyim Shaoul, have reviewed this pledge signed by
Salim Shaoul, who is under my guardianship, and I have no objection to any measure
or action that the school administration may take against him if it finds that he has misbehaved
or violated school orders, whatever they may be.
Baghdad on October 4, 1953
Signature of the student's guardian ⟦Hayyim Shaoul⟧
Shamash Secondary School
Baghdad
Admission Requirements
1 - Students who have passed the primary school examination are admitted to the first intermediate grade.
2 - Students who have passed the entrance exam are admitted to the fourth preparatory grade.
3 - Students who have passed or have a re-sit status in the intermediate school exam participate in the entrance exam.
4 - Every student must submit, upon admission, a file containing the following documents:
A - A transfer certificate from their school, certified by the Directorate of Education ⟦...⟧
B - A medical certificate confirming freedom from contagious diseases.
C - A vaccination certificate against smallpox and typhoid.
D - Civil Status Identity Document (Nufus).
E - Two copies of their photograph.
5 - The student must be of good conduct and reputation.
Student's name (according to the Nufus book): ⟦illegible⟧
Address (according to the Nufus book):
Date of birth (according to the Nufus book):
Student's current address:
School transferred from:
Grade transferred from:
Result in the grade transferred from:
The last general exam passed and its date:
Student's guardian - Name: ⟦illegible⟧
Student's guardian - Relationship: ⟦illegible⟧
Student's guardian - Profession: ⟦illegible⟧
Student's guardian - Address: ⟦illegible⟧
DR. ALBERT RABY
Tel. { Clinic 6561 / Res. 6010
Dr. Albert Raby
Telephone { Clinic: 6561 / Residence: 6010
18 / 11 / 57
⟦Shamash Secondary School⟧
⟦The Principal⟧
Signature of the student's guardian
Shamash Secondary School
Baghdad
Admission Requirements
1 - Students who have passed the primary school examination are admitted to the first intermediate grade.
2 - Students who pass the entrance examination are admitted to the fourth preparatory grade.
3 - Students who passed or have to resit the intermediate school examination participate in the entrance examination.
4 - Upon admission, every student must submit a file containing the following documents:
a - A transfer certificate from their school certified by the Directorate of Education of the Governorate.
b - A medical certificate stating they are free from infectious diseases.
c - A vaccination certificate against smallpox and typhoid.
d - The Civil Status Record (Daftar al-Nufus).
e - Two copies of their photograph.
5 - The student must be of good conduct and character.
Student's name (according to the Civil Status Record): ⟦Ibrahim Jassim Al-Beer⟧
His address (according to the Civil Status Record):
His date of birth (according to the Civil Status Record): ⟦Baghdad 1938⟧
Student's current address: ⟦Baghdad, Alwiyah No. ⟦...⟧⟧
The school transferred from: ⟦Frank Iny⟧
The grade transferred from: ⟦Third Intermediate⟧
His result in the grade transferred from: ⟦Passed⟧
The last general exam he passed and its date: ⟦First Session - Academic Year 1953 - 1954⟧
The student's guardian's name: ⟦Jassim Al-Beer⟧
His relationship: ⟦His father⟧
His profession:
His address:
Signature of the student's guardian
Frank Iny Intermediate School
Baghdad
SCHOOL
PRIMARY
Frank Iny School
Primary and Intermediate
Baghdad
Telephone Number: 91693
Number: ⟦illegible⟧
Date: 1957/⟦illegible⟧
To the Directorate of ⟦illegible⟧ School
That ⟦illegible⟧
Students (is one of the female students) of the ⟦illegible⟧ grade from the school
And he participated (she participated) in the general examination for the mentioned year and
Ethics and behavior, and based on his desire (her desire) to transfer to your school, we provided him/her
The following is a statement of his grades (her grades):
Religion | ⟦line⟧ |
Arabic Language | 78 | Seventy-eight
English Language | 75 | Seventy-five
French Language | ⟦line⟧ |
Geography | 78 | Seventy-eight
History | ⟦line⟧ |
Moral Duties | ⟦line⟧ |
Arithmetic | 92 | Ninety-two
Algebra | ⟦line⟧ |
Geometry | 82 | Eighty-two
Health and Biology | ⟦line⟧ |
Physics | 79 | Seventy-nine
Chemistry | ⟦line⟧ |
Objects and Health | ⟦line⟧ |
Drawing and Handicrafts | ⟦line⟧ |
Sports and Anthem | ⟦line⟧ |
Total: 484 Four hundred and eighty-four
Note that he/she failed the exam
The Principal
Frank Iny School
Baghdad
Frank Iny Intermediate School
Baghdad
Admission Form
Admission Requirements
1 - Admission to the first intermediate grade depends on passing the general examination for primary education.
2 - The student must not be known for bad character or have been convicted of a misdemeanor or felony.
3 - The student must attach to this form (1) the school document certified by the Directorate of Education of the Baghdad District (2) the
Civil Status Record (3) smallpox vaccination certificate (4) typhoid vaccination certificate (5) a medical certificate of freedom from
communicable diseases (6) two copies of his photograph.
4 - All documents mentioned in paragraph three listed above shall be kept in a special file on which the owner's name is written as it is
explained in the school document.
Student's name according to the school document:
Father's name and family surname according to the school document:
School transferred from:
Grade transferred from:
Result in the grade transferred from:
Year of graduation from primary school:
Name of the primary school graduated from:
Grade admitted to:
Civil Status Record Name:
Date of birth:
Address:
Nationality:
Student's guardian's name:
Relationship:
Profession:
Current address:
Student's current address:
Telephone number (if any):
Student's signature
Guardian's signature
Ministry of Social Affairs
Smallpox Vaccination Certificate
(Smallpox Vaccination Law issued in 1933)
Name ⟦Isaac⟧
Gender ⟦Male⟧ Age 12 years
Father's name ⟦Nissim⟧
Address ⟦⟦illegible⟧⟧
Date of second examination ⟦line⟧ Date of vaccination ⟦1/17⟧
Number of successful vaccinations
Public Vaccinator ⟦signature⟧ Date
The certificate is valid for five years from this date
Frank Iny Intermediate School
Baghdad
Admission Form
Admission Requirements
1 - Admission to the first intermediate grade depends on passing the general examination for primary education.
2 - The student must not be known for bad character or have been convicted of a misdemeanor or felony.
3 - The student must attach to this form (1) the school certificate certified by the Directorate of Education of the Baghdad District (2) the civil status
booklet (3) a vaccination certificate against smallpox (4) a vaccination certificate against typhoid (5) a medical certificate of freedom from
communicable diseases (6) two copies of his photograph.
4 - All documents mentioned in paragraph three listed above shall be kept in a special file on which the owner's name is written as it is
explained in the school certificate.
Student's name according to the school certificate: Munir Shaul
His father's name and family surname according to the school certificate: Habib Shaul
School transferred from: Al-Irshad
Grade transferred from: First
His result in the grade transferred from: Pass
Year of graduation from primary school: 1948 - 1949
Name of the primary school he graduated from:
Grade he was admitted to:
Name:
Date of birth: 1937
Address: Nahriya
Nationality:
His name:
His relationship:
His profession:
His current address:
Telephone number (if any):
Student's current address:
Student's signature
Guardian's signature
⟦illegible⟧ 2
⟦illegible⟧
⟦illegible⟧
⟦illegible⟧
⟦illegible⟧ ⟦...⟧ ⟦illegible⟧
⟦illegible⟧
⟦illegible⟧
⟦line⟧
⟦illegible⟧
⟦illegible⟧