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‫استمارة رقم ‪301‬‬

‫استمارة التقديم لبرنامج البعثات البحثية‬
‫))طلبة الدراسات العليا‬

‫المعلومات *‬
‫أول ً ‪ :‬العامة )تمل من قبل الطالب( ‪:‬‬

‫صورة‬
‫حديثة ملونة‬

‫‪ :‬المسم الكامل ‪-‬‬

‫‪ :‬محل وتاريخ الولةدة ‪-‬‬
‫ذكر‬
‫‪ -‬الجنس ‪:‬‬

‫انثى‬

‫‪ :‬التصال الحالي ‪-‬‬
‫الهاتف النقال ‪:‬‬

‫البريد اللكتروني‪:‬‬

‫المنطقة‬ ‫ عنوان السكن الحالي ‪ :‬المحافظة‬‫ــــــــــــــــــــــــــــــــــــــ‬ ‫الدار‬ ‫الزقاق‬ ‫المحلة‬ ‫ثانيًا‪ :‬الاكاديمية )تمل من قبل الجامعة(‪:‬‬ ‫مرحلة ةدرامسة الماجستير‬ ‫الجامعة‬ ‫الكلية‬ ‫مرحلة ةدرامسة الدكتوراه ‪-‬‬ ‫القسم‬ ‫التخصص‬ ‫العام‬ ‫التخصص الدقيق‬ ‫رقم‬ .

‫ــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ثالثًا‪ :‬السيرة الدراسية للطالب )تمل من قبل الجامعة(‬ ‫رقم وتاريخ المر الجامعي للقبول‬ ‫بالدراسات العليا )ماجستير ‪/‬داكتوراه(‬ ‫تاريخ المباشرة بالدراسات العليا‬ ‫)ماجستير ‪/‬داكتوراه(‬ .

‫تاريخ البدء بالبحث )الطروحة(‬ ‫التمديدات الممنوحة للطالب مع ذاكر‬ ‫الفترة الزمنية‬ ‫التاريخ المتوقع لنتهاء البحث )الطروحة(‬ .

‫‪) :‬رابعا ً ‪ :‬الوظيفية )تمل من قبل الطالب‬ ‫عقد‬ ‫مل ك ةدائم‬ ‫غير متعين في أية جهة‬ ‫موظف في وزارة التعليم العالي ‪-‬‬ .

‫‪ -‬موظف خارج وزارة التعليم العالي ‪:‬‬ ‫نؤكد المعلومات اعله وعليه وقعنا اةدناه ‪:‬‬ ‫عقد‬ ‫مل ك ةدائم‬ ‫وزارة ‪:‬‬ ‫دائرة ‪:‬‬ .

3‬‬ ‫مدير القسم‬ ‫‪.4‬‬ ‫عميد الكلية‬ ‫‪.5‬‬ ‫مدير العلقات‬ ‫الثقافية‬ ‫التوقيع‬ ‫التاريخ‬ .2‬‬ ‫المشرف‬ ‫‪.1‬‬ ‫الطالب‬ ‫‪.‫السم‬ ‫المنصب‬ ‫‪.

‫‪.6‬‬ ‫مساعد رئيس‬ ‫الجامعة‬ .

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PRSAF 302 Ministry of Higher Education and Scientific Research .

(302-1)Personal history: .R&D Postgraduate Research Scholarship Application Form (PRSAF) This form is designed for Research Scholarships students (postgraduate students) who wish to be considered as a “ visiting Research” according to Research Scholarships programme at foreign universities. fill all form in printed letter . Please .

Nationality : 3.1. E-mail: Female . Contact: Sex: Male Mobile No. Name of applicant (as written in passport) : 2.

5.) Master’s Course First year Second year(Research stage) Doctoral Course First year Second year (Research . Date of Birth Degree and stage currently enrolled in:)ِUniversity.college.Dep.4.

7. Short title of research project: .stage) 6. Passport No.

(302-2) Personal Details (Supervisor): Full name (as written in passport) : .

Current Contact: Mobile No. E-mail: .

: University: .Passport number: Dept.

College: Position: Major/and degree: .

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......................................................... ............etc................... ....................................................................................................... .......................................... ........... .......................................................... ........................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................. ....................................................... ...................................................................................................................................................... .......................................................................................................... ................................................................................................ ........................................................................................................................................................................................................................................................................................................................ .............................................................................................................................................................. .......... ......... ............................................................ methods............................................................................................. ....................................................................................................................... ..................................................................... ............................................................................................................................... ........................ ......................................................................................................................................................... ...................................................................................................................................................................................(302-3)Research project(Supervisor and student): Statement including general and specific aims of the study.... technology.......................................................................................................................................................................................................................................................................................................................................................................... .................................................................................................. .................................................................................................... ........................................................ ....................................................................................................................................................... .................. ....................... ....................................................................................................... ............................................................................................................................................................................................................................................. .................................................................................................................. ................ ................................................................................................................................................................................................................... ....... ..................................... ........................... ...............................................................................................................................................................................................................................................................................................

........... ..................................................................................................(302-4): Write a brief paragraph on how your research scholarship project will benefit the research work of your study(Supervisor and Student): .......................................................................................................................................................................................................................................... ......................................................... ................................... ........................................................................................................................................... .......................................................................... ..................................... ......................................................................................................................................................................................................................................................................................................................... (302-5) :The value of research Scholarship to me(Student): Describe briefly the type of research project you would like to carry out during your research work and how the research scholarship would help you to do this : ........................................................................................ .................................................................................................................................................................................................... ...................................... ............................................................................................ ............................................................................................................. ......................................................................................................................................................... .................................................................. ................................................................................................................................................................................. .................................... .................................................................................................................................................................................................................................................................................................................................................... ....................................................................... ................. ............................................................................................. ................................................................................................................................................................. .................................................................................................................................................................................. .......................................... ... ............................................................................................................ ........................................ ......................................................................................................................................... ................................................................................................................................................................................... ............................................................................................................................................................................................................................................ .................................................................................................................................... .................................................................................................................... .....................................

country) Period of Attendance Month/Year / / Number Years of . (undergraduate) Location(city.(302-6) Qualifications: (302-6-1) Academic history : Name of Institution Higher Education/name of university and Dept.

Location Period Month/Year .Name of university and Dept Master’s Course Name of university and Dept Doctoral Course / / / / (302-6-2) Job experience: Name of company/Institution and Job description 1.

2. 3. 4. (302-6-3) English Language Proficiency: English language Weak Intermediate Good V.good Excellent .

Speaking Listening Reading Writing (302-7) Comments (Please additional statement as necessary) a . how would you rate the applicant’s overall academic/ Research work performance? . In relation to the quality of completed work.

skills and/or experience..etc. . Please comment on the applicant’s research/publications.b.

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.......... ............................................................................................................................................................................................................................................................................................................. ............................... Previous academic awards and research experience or special skills relevant for elected project of research scholarship.......................................................................................................... ..............................................................................................(302-8)Any other relevant information e........................... ......................................................... ...................................................................................... .........................g.......................................... ............... ..................................................

Name : Position : Student Signature : Date: .Signatures : We certify that all the information provided on this form and in the accompanying documents is complete and accurate to the best of my knowledge.

‫استمارة رقم‬ ‫‪303‬‬ ‫استمارة الرأي والمصادقة للترشيح ضمن برنامج‬ ‫البعثات البحثية‬ ‫)‪ (303-1‬رأي مشرف الطالب والخطوات التي اتخذها‬ ‫باتجاه سفر الطالب‬ .

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‫)‪ (303-2‬رأي اللجنة العلمية في القسم أو مايناظرها ومدى‬ ‫تأييدها سفر الطالب من عدمه‬ .

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‫)‪ (303-3‬رأي قسم العلقات الثقافية في الجامعة أو مايناظرها‬ ‫والجراءات التي قامت بها باتجاه سفر الطالب ‪:‬‬ .

5 .4 .7 .6 .1 ..3 .2 .