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قارﻌﻟا ﻲﻓ مﻴﻠﻌﺘﻟا رﻴوطﺘﻟ ﺎﻴﻠﻌﻟا ﺔﺌﻴﻬﻠﻟا
ﻕﺍﺭﻌﻟﺍ ﺔﻳﺭﻭﻬﻣﺟ

The Higher Committee for Education Development in Iraq
http://www.hcediraq.org
ءﺍﺭﺯﻭﻟﺍ ﺱﻳﺋﺭ ﺏﺗﻛﻣ
2010 - 2009 ﻡﺎﻌﻠﻟ ﺔﻳﺳﺍﺭﺩﻟﺍ ﺔﺣﻧﻣﻟﺍ ﺞﻣﺎﻧﺭﺑﻟ ﻡﻳﺩﻘﺗﻟﺍ ﺓﺭﺎﻣﺗﺳﺍ
Application Form to the 2009-2010 Scholarship Program
ﺓﺭﻘﻓ ﻝﻛﻟ ﺹﺻﺧﻣﻟﺍ ﻥﺎﻛﻣﻟﺍ ﻝﺧﺍﺩ ﻲﻓ ﺩﻭﺟﻭﻣﻟﺍ ﺏﺳﺎﻧﻣﻟﺍ ﺏﺍﻭﺟﻟﺍ ﺭﺎﻳﺗﺧﺍ ﻭﺍ ﺔﻋﺎﺑﻁ ءﺎﺟﺭﻟﺍ
ﺔﻌﺑﺎﺗﻣﻟﺍ ﺽﺭﻐﻟ ﺔﻋﻭﺑﻁﻣﻟﺍ ﺓﺭﺎﻣﺗﺳﻻﺎﺑ ﻅﺎﻔﺗﺣﻻﺍﺍ ﻝﺿﻔﻳ . (Submit) ﻡﻳﺩﻘﺗﻟﺍﺍ ﺡﺎﺗﻔﻣ ﻝﻋ ﻁﻐﺿﻟﺎﺑ ﺎﻳﻠﻌﻟﺍ ﺔﻧﺟﻠﻟﺍ ﻰﻟﺍ ﺎﻬﻟﺎﺳﺭﺍﻭ ﻡﻳﺩﻘﺗﻟﺍ ﺓﺭﺎﻣﺗﺳﺍ ءﻲﻠﻣ ﻰﺟﺭﻳ
Please type or select your answers in the space provided for each item. When finished, click Submit Form to send your data.
Current Date
APID#
9/8/10
0 9
ﻲﻟﺎﺣﻟﺍ ﺦﻳﺭﺎﺗﻟﺍ
Submit
Print Form
Personal Information
2. Birth Information
ﺓﺩﻻﻭﻟﺍ
1. Name
ﻝﺣﻣﻭ ﺦﻳﺭﺎﺗ ﻥﻋ ﺕﺎﻣﻭﻠﻌﻣ
Family Name
First Name
Middle Name
Sur Name
Date of Birth
ﺔﻠﺋﺎﻌﻟﺍ ﻡﺳﺍ
ﻝﻭﻷﺍ ﻡﺳﻻﺍ
ﻁﺳﻭﻷﺍ ﻡﺳﻻﺍ
ﻼﻠﻘﺑ
ﺩﻟﻭﺗﻟﺍ
Mar 2, 1993
ﺦﻳﺭﺎﺗ
ﺔﻳﺑﺭﻌﻟﺍ ﺔﻐﻠﻟﺎﺑ ﻡﺳﻻﺍ يدﺮﮐ
ﺪﻧر لﻤﺎﮐ دﺎﺸﻟد
Country
ﺩﻠﺑﻟﺍ Iraq
Name in English Kurdi
Rand
Kamal
Dilshad
Name in other language
City/Town ﺔﻧﻳﺩﻣﻟﺍﺍ

Sulaymaniyah
یدرﻮﮐ ﺪﻧ هر لﻤﺎﮐ دﺎﺸڵد
ﺩﺟﻭ ﻥﺍ ﻯﺭﺧﺍ ﺔﻐﻠﺑ ﻡﺳﻻﺍ
3. Permanent Home Address in Your Home Country and Contact Information ﻙﺑ ﻝﺎﺻﺗﻼﻟ ﺕﺎﻣﻭﻠﻌﻣﻭ ﻙﺩﻠﺑ ﻲﻓ ﻡﺋﺍﺩﻟﺍ ﻥﻛﺳﻟﺍ ﻥﺍﻭﻧﻋ

Province

City/Town
Street/Sect.
Home No.
Sulaymaniyah
Kurdistan
Sarchnar
3/14/119
Mobile Telephone
Home Telephone
E-mail Address
7,702,165,946
533,181,132
randkurdi@ymail.com
Emergency Contact Person
ﻙﺑ ﻝﺎﺻﺗﻻﺍ ﺭﺫﻌﺗ ﺔﻟﺎﺣ ﻲﻓ ﻪﺑ ﻝﺎﺻﺗﻼﻟ ﻝﻭﻻﺍ ﺹﺧﺷﻟﺍ ﻥﻋ ﺕﺎﻣﻭﻠﻌﻣ
Mobile Telephone
E-mail Address
my mother
7,701,206,726
rawkykd_kurdy@yahoo.com
4. Personal Data ﺔﻳﺻﺧﺷ ﺕﺎﻣﻭﻠﻌﻣ
5. ID Number ﺭﺍﺩﺻﻻﺍ ﻝﺣﻣﻭ ﺎﻬﺧﻳﺭﺎﺗﻭ ﺔﻳﻧﺩﻣﻟﺍ ﻝﺍﻭﺣﻻﺍ ﺔﻳﻭﻫ ﻡﻗﺭ

Gender
Marital Status
ﺱﻧﺟﻟﺍ
ﺔﻳﺟﻭﺯﻟﺍ
ID # 621888
Date Sep 5, 1998
ﺔﻟﺎﺣﻟﺍ
Male
Single
City of Issuance Sulaymaniyah
7. Tamwenia ﻡﻌﻟﻭﻣﺎﺗ ﻼﺑﻁﺎﻗﺓ ﻼﺗﻣﻭﻳﻧﻳﺓ
6. Job Status ﻑﻅﻭﻣ ﻡﺩﻘﺗﻣﻟﺍ ﻥﺎﻛ ﻥﺍ ﺔﻔﻳﻅﻭﻟﺍ ﻥﻋ ﺕﺎﻣﻭﻠﻌﻣ
Number
Employment Status
Student
ﺭﻘﻣ
7,004,219
ﻼﺑﻁﺎﻗﺓ ﻼﺗﻣﻭﻳﻧﻳﺓ
Tam No.
Department and Ministry Affiliation Address
ﻑﻅﻭﻣﻟﺍ
none
Year
ﺎﻬﻟ ﺏﺳﺗﻧﻣﻟﺍ ﺓﺭﺋﺍﺩﻟﺍﻭ ﺓﺭﺍﺯﻭﻟﺍ ﻥﺍﻭﻧﻋ
ﻼﺳﻧﺓ
2,010.2011
First Employment Date ﻥﻳﻳﻌﺗ ﻝﻭﺍ ﺦﻳﺭﺎﺗ
none
Province
Sulaymaniyah
Total Years of Employment ﺔﻣﺩﺧﻟﺍ ﺕﺍﻭﻧﺳ ﺩﺩﻋ

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Study Information
ﺏﻭﻠﻁﻣﻟﺍ ﺹﺎﺻﺗﺧﻻﺍﻭ ﺔﻳﻣﻠﻌﻟﺍ ﺔﺟﺭﺩﻟﺍ ﻥﻋ ﺕﺎﻣﻭﻠﻌﻣ
For more information about particular fields, please go to Guide page in website.
ﺓﺭﻳﺧﻻﺍ ﺔﺣﻔﺻﻟﺍ ﺔﻌﺟﺍﺭﻣ ﻰﺟﺭﻳ , ﺔﺑﻭﻠﻁﻣﻟﺍ ﺕﺎﺻﺎﺻﺗﺧﻻﺍ ﻥﻋ ﻼﻳﺻﻔﺗ ﺭﺛﻛﺍ ﺕﺎﻣﻭﻠﻌﻣﻟ

8. Degree Objective ﺔﺑﻭﻠﻁﻣﻟﺍ ﺔﻳﻣﻠﻌﻟﺍ ﺔﺟﺭﺩﻟﺍ
Diploma (2 years)
Bachelors
Master
Doctorate
Other
For Bachelors Degree programs , select three (3) Fields of Study below. Upon selecting a study, please prioritize it by using the drop
down that appears in the right column.
(Priority) ﺏﻼﻧﺳﺑﺓ ﻝﻠﻁﻠﺑﺓ ﻼﻣﺗﻗﺩﻣﻳﻧ ﻝﻠﺣﺻﻭﻟ ﻊﻠﯩ ﺵﻫﺍﺩﺓ ﻼﺑﻛﻟﻭﺭﻳﻭﺳ ﻱﺭﺟﯩ ﺎﺧﺗﻳﺍﺭ ﺙﻼﺛﺓ ﺎﺧﺗﺻﺎﺻﺎﺗ ﻝﻟﺩﺭﺎﺳﺓ ﻼﻣﻁﻟﻭﺑﺓ ﻭﺣﺳﺑ ﺍﻼﻔﺿﻠﻳﺓ ﻡﻧ ﺥﻼﻟ ﺍﻼﻗﺎﺋﻣﺓ ﻼﻣﻧﺳﺩﻟﺓ ﻑﻳ ﻼﺣﻘﻟ
9.) Field of Study ﺏﻭﻠﻁﻣﻟﺍ ﻲﺳﺍﺭﺩﻟﺍ ﺹﺎﺻﺗﺧﻻﺍ
Priority
Agriculture
Other
0
Allied Health Specializations
Other
0
Architecture
City/Urban, Community and Regional Planning
Other
1
Arts Visual & Performing
Drama and Dramatics/Theatre Arts, General
Other
3
Business, Management, & Marketing MBA with a concentration in Petroleum Management
Other
0
Communications & Journalism
Cinema
Other
3
Dentistry
Implantology
Other
2
Education
Other
0
Engineering
Architectural Engineering
Other
1
Family, Consumer & Human Science
Other
0
Law and Legal Studies
Other
0
Liberal Arts
Other
0
Library Science/Librarianship
Other
0
Life Science
Other
0
Medicine
Other
0
Political Science
Other
0
Public Administration
Please Select...
Other
0
Psychology
Please Select...
Other
0
Science
Please Select...
Other
0
Other (Explain)
10. Preferred Country of Study ﻪﻳﻓ ﺔﺳﺍﺭﺩﻟﺍ ﻝﺿﻔﺗ ﻱﺫﻟﺍ ﺩﻠﺑﻟﺍ
United States
11. Previous Academic Scholarships






ﺔﻘﺑﺎﺳﻟﺍ ﺔﻳﺳﺍﺭﺩﻟﺍ ﺢﻧﻣﻟ
1.
2.
3.

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12. Native Language(s) ﻡﺩﻘﺗﻣﻠﻟ ﺔﻳﺳﺎﺳﻻﺍﺔﻐﻠﻟﺍ
Kurdish
Other Arabic , English
13. Standardized English Test Scores

ﺔﻳﺯﻳﻠﻛﻧﻻﺍ ﺔﻐﻠﻟﺍ ﺕﺍﺭﺎﺑﺗﺧﺍ ﻥﻋ ﺕﺎﻣﻭﻠﻌﻣ
Test Name:
Date Taken or To Be Taken:
Score:
Location:
Email Address of Location:
TOEFL
IELTS
ITP
SAT
ACT
GRE
Other
14. Educational Background ﻡﺩﻘﺗﻣﻠﻟ ﺔﻳﻣﻠﻌﻟﺍ ﺔﻳﻔﻠﺧﻟﺍ
Degrees Received
Institution Name
Institution
Dates Attended
Dates Attended
Major Field
Grade Point
ﻼﺷﻫﺍﺩﺎﺗ ﻼﺣﺎﺻﻟ ﻊﻠﻳﻫﺍ ﻼﻣﺗﻗﺩﻣ (No Abbreviation)
City/Country
FROM
TO
of Study
Average
ﺔﻳﻠﻛﻟﺍ,ﺩﻬﻌﻣﻟﺍ, ﺔﺳﺭﺩﻣﻟﺍ ﻡﺳﺍ
ﺔﻧﻳﺩﻣ/ﺔﻟﻭﺩ) ﻊﻗﻭﻣﻟﺍ)
ﺔﺳﺍﺭﺩﻟﺍ ﻝﻘﺣ
ﺔﺑﺳﻧﻟﺎﺑ ﻝﺩﻌﻣﻟﺍ
ﻼﻣﺎﻛ
ﺔﻳﻭﺋﻣﻟﺍ
High School:
Roshnbeer
Sulaymanyah
Oct 15, 2007
Jun 16, 2010
Scientific
94
Diploma:
Bachelors:
Master:
High Diploma:
Other:

15. Explain Any Gaps in your Education:
ﺔﺳﺭﺩﻣﻟﺍ ﻭﺍ ﺔﻌﻣﺎﺟﻟﺍ ﻲﻓ ﻙﻣﻳﻠﻌﺗ ﻲﻓ ﻉﺎﻁﻘﻧﺍ ﻙﺎﻧﻫ ﻥﺎﻛ ﻥﺍ ﺢﺿﻭ
16. Have you ever been dismissed from a
Yes
No
School or University?
َ
؟ﺔﻌﻣﺎﺟ ﻭَﺃ ﺔﺳﺭﺩﻣ ْﻥِﻣ ﺕﺑﻗﻭﻋ ْﻥﺃ َﻕَﺑَﺳ ﻝﻫ
If yes, Please explain why:
؟؟ﺍﺫﺎﻣﻟ ﻡﻌﻧ ﻙﺑﺍﻭﺟ ﻥﺎﻛ ﺍﺫﺍ
17. HCED IRAQ
ﺕﺎﻧﺎﻳﺑﻟﺍ ﺓﺩﻋﺎﻗ
Database Manager:
Date:
Signature:
Signed By
Notes:
Photo ﻼﺻﻭﺭﺓ

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