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‫ﺍﻟﺠﻤﻬﻭﺭﻴـﺔ ﺍﻟﻌﺭﺒﻴـﺔ ﺍﻟﺴـﻭﺭﻴﺔ‬

‫ﺻﻮرة‬ ‫ﺍﻟﺠﻤﻌﻴﺔ ﺍﻟﻌﻠﻤﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ ﻟﻠﺠـﻭﺩﺓ‬


‫ﺷﺨﺼﯿﺔ‬ ‫ﺭﻗﻡ ﺍﻹﺸﻬﺎﺭ ‪٢٠٠٤/٣٨٣‬‬

‫ﻃﻠﺐ اﻧﺘﺴﺎب‬
‫ﻴﺭﺠﻰ ﻤلﺀ ﻫﺫﺍ ﺍﻟﻁﻠﺏ ﻭﺇﺭﺴﺎﻟﻪ ﺇﻟﻰ ﺍﻟﺠﻤﻌﻴﺔ ﻤﺭﻓﻘﺎﹰ ﻤﻌﻪ ﺼﻭﺭﺓ ﻭﺍﻀﺤﺔ ﻋﻥ ﺍﻟﻬﻭﻴﺔ ﺍﻟﺸﺨﺼﻴﺔ‪ ،‬ﻭﺼﻭﺭﺓ ﻋﻥ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﻌﻠﻤﻴﺔ‬
‫ﺍﻷﺨﻴﺭﺓ‪ ،‬ﻭﺼﻭﺭﺓ ﺸﺨﺼﻴﺔ ﻤﻠﻭﻨﺔ ﺤﺩﻴﺜﺔ‪ ،‬ﻤﻊ ﺍﻟﻌﻠﻡ ﺍﻨﻪ ﺴﻴﺘﻡ ﺍﻻﺘﺼﺎل ﺒﻜﻡ ﻹﺒﻼﻏﻜﻡ ﺒﻘﺒﻭل ﺍﻟﻁﻠﺏ ﻤﺒﺩﺌﻴﺎﹰ ﺃﻭ ﺒﺎﻻﻋﺘﺫﺍﺭ‪.‬‬
‫‪ ‬‬
‫ﻤﻌﻠﻭﻤﺎﺕ ﺸﺨﺼﻴﺔ ‪:‬‬
‫‪.........................................................................................................‬‬
‫‪‬‬
‫ﺍﻻﺴﻡ ﺍﻟﺜﻼﺜﻲ‪ ..................................................................................................... :‬ﺍﻻﺴﻡ ﺒﺎﻟﻠﻐﺔ ﺍﻹﻨﻜﻠﻴﺯﻴﺔ‪:‬‬
‫ﻤﻜﺎﻥ ﻭﺘﺎﺭﻴﺦ ﺍﻟﻤﻴﻼﺩ‪ ...................................................................................... :‬ﻤﻜﺎﻥ ﺍﻹﻗﺎﻤﺔ ﺍﻟﺤﺎﻟﻲ‪............................................................................................................ :‬‬

‫‪.................................................................................................................‬‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ‪:‬‬ ‫‪ ‬ﺃﻨﺜﻰ‬ ‫ﺍﻟﺠﻨﺱ‪  :‬ﺫﻜﺭ‬


‫‪ ‬ﻭﺴﻁ‬ ‫‪ ‬ﺠﻴﺩ‬ ‫‪ ‬ﺠﻴﺩ ﺠﺩﺍﹰ‬ ‫‪........................................................‬‬ ‫ﺍﻟﻠﻐﺎﺕ ﺍﻷﺠﻨﺒﻴﺔ ﻭﻤﺴﺘﻭﻯ ﺍﺘﻘﺎﻨﻬﺎ ‪:‬‬
‫‪ ‬ﻭﺴﻁ‬ ‫‪ ‬ﺠﻴﺩ‬ ‫‪ ‬ﺠﻴﺩ ﺠﺩﺍﹰ‬ ‫‪........................................................‬‬

‫‪................................................................‬‬ ‫ﻫﺎﺘﻑ ﺍﻟﻌﻤل ‪................................................................‬ﺍﻟﻬﺎﺘﻑ ﺍﻟﻤﺤﻤﻭل‬ ‫‪...............................................................‬‬ ‫ﻫﺎﺘﻑ ﺍﻟﻤﻨﺯل ‪:‬‬


‫‪................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ ﺍﻟﺒﺭﻴﺩﻱ ‪:‬‬
‫‪...................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻔﺎﻜﺱ ‪:‬‬
‫ﺍﻟﺒﺭﻴﺩ ﺍﻹﻟﻜﺘﺭﻭﻨﻲ ‪:‬‬
‫‪........................................................................................................................................................................................................................................................‬‬
‫‪‬‬
‫ﺍﻟﺘﻭﻗﻴﻊ‪:‬‬ ‫‪/‬‬ ‫ﻟﻼﺘﺼﺎل‪/ :‬‬
‫‪..............................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻤﻔﻀل‬
‫ﺍﻟﻁﻠﺏ ‪:‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ‬
‫ﺘﻘﺩﻴﻡ‬ ‫ﺘﺎﺭﻴﺦ‬

‫ﺍﻟﻤﺅﻫﻼﺕ ﺍﻟﻌﻠﻤﻴﺔ‪:‬‬
‫‪....................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻤﺅﻫل ﺍﻟﻌﻠﻤﻲ ﺍﻷﺨﻴﺭ‪:‬‬
‫‪................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﺘﺨﺼﺹ‪:‬‬
‫‪.....................................................................................................................................................................................................................................‬‬ ‫ﺴﻨﺔ ﻭﻤﻜﺎﻥ ﺍﻟﺘﺤﺼﻴل ﺍﻟﻌﻠﻤﻲ‪:‬‬

‫‪.....................................................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻤل ﺍﻟﺤﺎﻟﻲ ﻭﺍﻟﺨﺒﺭﺍﺕ ﺍﻟﻤﻬﻨﻴﺔ ﺍﻟﻤﻜﺘﺴﺒﺔ‪:‬‬


‫‪.......................................................................................................................................................................................................................................................................................... .................‬‬

‫‪........................................................................................................................................................................................‬‬ ‫ﺍﻟﺨﺒﺭﺓ ﻓﻲ ﻤﺠﺎل ﺍﻟﺠﻭﺩﺓ ﻭﺍﻟﺸﻬﺎﺩﺍﺕ ﺫﺍﺕ ﺍﻟﺼﻠﺔ‪:‬‬


‫‪............................................................................................................................................................................................................................................................................................................‬‬

‫ﻤﻌﻠﻭﻤﺎﺕ ﺇﻀﺎﻓﻴﺔ ‪:‬‬


‫‪......................................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻀﻭﻴﺔ ﻓﻲ ﺠﻤﻌﻴﺎﺕ ﺃﺨﺭﻯ ﺃﻭ ﺘﻨﻅﻴﻤﺎﺕ ﻤﻬﻨﻴﺔ ‪:‬‬
‫‪................................................................................................................................................................................................................................................‬‬ ‫ﺍﻻﻫﺘﻤﺎﻤﺎﺕ ﻭﺍﻟﻨﺸﺎﻁﺎﺕ ‪:‬‬
‫‪.....................................................................................................................................................................................................................................‬‬ ‫ﺃﺴﺒﺎﺏ ﺍﻨﺘﺴﺎﺒﻙ ﺇﻟﻰ ﺍﻟﺠﻤﻌﻴﺔ ‪:‬‬
‫‪ ..........................................................................................................................................‬‬ ‫ﻤﺎ ﻫﻲ ﺍﻟﻨﺸﺎﻁﺎﺕ ﺍﻟﺘﻲ ﻴﻤﻜﻨﻙ ﺍﻟﻤﺴﺎﻫﻤﺔ ﺒﻬﺎ ﻓﻲ ﺩﻋﻡ ﺃﻫﺩﺍﻑ ﺍﻟﺠﻤﻌﻴﺔ‪:‬‬
‫‪‬‬
‫‪............................................................................................................................................................................................................................................................................................................‬‬

‫ﺍﻟﺘﻭﻗﻴﻊ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺘﻘﺩﻴﻡ ﺍﻟﻁﻠﺏ‪:‬‬


‫‪........................................................................................................................................................................................................................................................‬‬ ‫ﻗﺭﺍﺭ ﻤﺠﻠﺱ ﺍﻹﺩﺍﺭﺓ‪:‬‬

‫ﺩﻤﺸﻕ – ﺍﻟﺤﺠﺎﺯ – ﻤﺒﻨﻰ ﺍﻟﺒﺭﻴﺩ ﺍﻟﻤﺭﻜﺯﻱ‪ -‬ﺍﻟﻁﺎﺒﻕ ﺍﻟﺜﺎﻟﺙ – ﻫﺎﺘﻑ‪ – ٢٤٥٩٤١٨ :‬ﻓﺎﻜﺱ‪ – ٢٤٦٠٢٩٨ :‬ﺹ‪.‬ﺏ‪٣٠٢٥ :‬‬
‫ﺍﻟﺒﺭﻴﺩ ﺍﻻﻟﻜﺘﺭﻭﻨﻲ‪sssq@mail.sy ; sssquality@sssquality.com :‬‬