Appendix B: Study Abroad Form Requiring a Guardians 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:
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 Guardians Consent |