‫ﮔﺰﺍﺭﺵ ﻛﺎﺭﺁﻣﻮﺯﻱ‬

‫ﺩﺍﻧﺸﻜﺪﻩ‪ ................................... :‬ﺑﺨﺶ‪.................................................:‬‬

‫ﻣﻜﺎﻥ‪:‬‬

‫ﻣﻮﺿﻮﻉ‪:‬‬

‫ﺍﺳﺘﺎﺩ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﺗﻬﻴﻪ ﻛﻨﻨﺪﻩ‪:‬‬
 ‫ﮔﺰﺍﺭﺵ ﭘﻴﺸﺮﻓﺖ ﻛﺎﺭﺁﻣﻮﺯﻱ‬
‫ﺍﺳﺘﺎﺩ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﻧﺎﻡ ﻭ ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ ﺩﺍﻧﺸﺠﻮ‪:‬‬
‫ﺳﺮﭘﺮﺳﺖ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﺷﻤﺎﺭﻩ ﺩﺍﻧﺸﺠﻮﻳﻲ‪:‬‬
‫ﺗﺮﻡ ﻭ ﻛﺪ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﺭﺷﺘﻪ‪/‬ﮔﺮﺍﻳﺶ‪:‬‬
‫ﻣﻮﺿﻮﻉ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﻣﺤﻞ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﻓﻌﺎﻟﻴﺖ ﺍﻧﺠﺎﻡ ﺷﺪﻩ‪:‬‬

‫ﻓﻌﺎﻟﻴﺖ ﻫﺎﻱ ﺁﺗﻲ‪:‬‬

‫ﻣﺸﻜﻼﺕ‪:‬‬

‫ﭘﻴﺸﻨﻬﺎﺩﺍﺕ‪:‬‬

‫ﺗﺎﺭﻳﺦ ﻭ ﺍﻣﻀﺎ ﺩﺍﻧﺸﺠﻮ‬

‫ﻧﻈﺮﻳﻪ ﺳﺮﭘﺮﺳﺖ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﺗﺎﺭﻳﺦ ﻭ ﺍﻣﻀﺎ ﺳﺮﭘﺮﺳﺖ ﻛﺎﺭﺁﻣﻮﺯﻱ‬

‫ﻧﻈﺮﻳﻪ ﺍﺳﺘﺎﺩ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﺗﺎﺭﻳﺦ ﻭ ﺍﻣﻀﺎ ﺍﺳﺘﺎﺩ ﻛﺎﺭﺁﻣﻮﺯﻱ‬

 ‫ﻓﺮﻡ ﺧﻼﺻﻪ ﻣﻜﺎﻥ ﻛﺎﺭﺁﻣﻮﺯﻱ‬

‫ﺍﺳﺘﺎﺩ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﻧﺎﻡ ﻭ ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ ﺩﺍﻧﺸﺠﻮ‪:‬‬

‫ﺳﺮﭘﺮﺳﺖ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﺷﻤﺎﺭﻩ ﺩﺍﻧﺸﺠﻮﻳﻲ‪:‬‬
‫ﺗﺮﻡ ﻭ ﻛﺪ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﺭﺷﺘﻪ‪/‬ﮔﺮﺍﻳﺶ‪:‬‬
‫ﻣﻮﺿﻮﻉ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﻣﺤﻞ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﻧﺎﻡ ﻣﺤﻞ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﺁﺩﺭﺱ ﻭ ﺗﻠﻔﻦ ﻣﺤﻞ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﺳﺮﭘﺮﺳﺖ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﻋﻨﻮﺍﻥ ﻭ ﻣﻮﺿﻮﻉ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﺷﺮﻭﻉ ﻭ ﺭﻭﺯﻫﺎﻱ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﺗﺎﺭﻳﺦ ﻭ ﺍﻣﻀﺎ ﺍﺳﺘﺎﺩ ﻛﺎﺭﺁﻣﻮﺯﻱ‬

 ‫ﻓﺮﻡ ﭘﺎﻳﺎﻥ ﺩﻭﺭﻩ ﻛﺎﺭﺁﻣﻮﺯﻱ‬

‫ﺍﺳﺘﺎﺩ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﻧﺎﻡ ﻭ ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ ﺩﺍﻧﺸﺠﻮ‪:‬‬

‫ﺳﺮﭘﺮﺳﺖ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﺷﻤﺎﺭﻩ ﺩﺍﻧﺸﺠﻮﻳﻲ‪:‬‬
‫ﺗﺮﻡ ﻭ ﻛﺪ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﺭﺷﺘﻪ‪/‬ﮔﺮﺍﻳﺶ‪:‬‬
‫ﻣﻮﺿﻮﻉ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬ ‫ﻣﺤﻞ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﺿﻌﻴﻒ ‪1‬‬ ‫ﻣﺘﻮﺳﻂ ‪2‬‬ ‫ﺧﻮﺏ ‪3‬‬ ‫ﻋﺎﻟﻲ ‪4‬‬ ‫ﻧﻈﺮﻳﺎﺕ ﺳﺮﭘﺮﺳﺖ ﻛﺎﺭﺁﻣﻮﺯﻱ‬
‫ﻧﻤﺮﻩ‬ ‫ﻧﻤﺮﻩ‬ ‫ﻧﻤﺮﻩ‬ ‫ﻧﻤﺮﻩ‬
‫ﺣﻀﻮﺭ ﻭ ﻏﻴﺎﺏ ﺭﻋﺎﻳﺖ ﻧﻈﻢ ﻭ ﺗﺮﺗﻴﺐ ﺩﺭ ﻭﺍﺣﺪ ﺻﻨﻌﺘﻲ‬
‫ﻣﻴﺰﺍﻥ ﻋﻼﻗﻪ ﺑﻪ ﻫﻤﻜﺎﺭﻱ ﻭ ﻓﺮﺍﮔﻴﺮﻱ‬
‫ﻛﺴﺐ ﺗﺠﺮﺑﻪ ﻭ ﺑﻜﺎﺭﮔﻴﺮﻱ ﺗﻜﻨﻴﻜﻬﺎ‬
‫ﺍﺭﺯﺵ ﭘﻴﺸﻨﻬﺎﺩﺍﺕ ﻛﺎﺭﺁﻣﻮﺯ ﺟﻬﺖ ﺑﻬﺒﻮﺩ ﻛﺎﺭ‬
‫ﻛﻴﻔﻴﺖ ﮔﺰﺍﺭﺷﻬﺎﻱ ﻛﺎﺭﺁﻣﻮﺯ ﺑﻪ ﻭﺍﺣﺪ ﺻﻨﻌﺘﻲ‬

‫ﺗﻮﺿﻴﺢ‬ ‫ﭘﻴﺸﻨﻬﺎﺩﺍﺕ ﺳﺮﭘﺮﺳﺖ ﻛﺎﺭﺁﻣﻮﺯ ﺟﻬﺖ ﺑﻬﺒﻮﺩ ﺑﺮﻧﺎﻣﻪ‬

‫ﻛﺎﺭﺁﻣﻮﺯﻱ‬

‫ﺍﻣﻀﺎ ﻭ ﻣﻬﺮ ﺳﺮﭘﺮﺳﺖ ﻛﺎﺭﺁﻣﻮﺯﻱ‪:‬‬

‫ﺍﻣﻀﺎ ﺍﺳﺘﺎﺩ ﻛﺎﺭﺁﻣﻮﺯﻱ‬ ‫ﺗﺎﺭﻳﺦ‪:‬‬
‫ﺗﺎﺭﻳﺦ‪:‬‬

‫ﻧﻤﺮﻩ ﻧﻬﺎﻳﻲ ﺑﻪ ﻋﺪﺩ‬ ‫ﻧﻤﺮﻩ ﻧﻬﺎﻳﻲ ﺑﻪ ﺣﺮﻭﻑ‬

 ‫ﻓﺮﻡ ﺷﻤﺎﺭﻩ‪3‬‬ ‫ﻣﻌﺎﻭﻧﺖ ﭘﮋﻭﻫﺸﻲ – ﺩﻓﺘﺮ ﺍﺭﺗﺒﺎﻁ ﺑﺎ ﺻﻨﻌﺖ ﺩﺍﻧﺸﮕﺎﻩ‬

‫ﻓﺮﻡ ﺗﺎﻳﻴﺪﻳﻪ ﺗﺤﻮﻳﻞ ﮔﺰﺍﺭﺷﺎﺕ ﺩﺍﻧﺸﺠﻮ ﺑﺮﺍﻱ ﮔﺬﺭﺍﻧﺪﻥ ﺩﻭﺭﻩ ﻛﺎﺭﺁﻣﻮﺯﻱ‬ ‫‪U‬‬

‫ﻣﺴﺌﻮﻝ ﻣﺤﺘﺮﻡ ﻛﺘﺎﺑﺨﺎﻧﻪ‬

‫ﺑﺎﺳﻼﻡ؛‬
‫ﺍﺣﺘﺮﺍﻣ ًﺎ ﻳﻚ ﻧﺴﺨﻪ ﮔﺰﺍﺭﺵ ﻛﺎﻣﻞ ﻛﺎﺭﺁﻣﻮﺯﻱ ‪ /‬ﭘﺮﻭژﻩ ﺍﻳﻨﺠﺎﻧﺐ ‪ .......................................‬ﺩﺍﻧﺸﺠﻮﻱ ﺭﺷﺘﻪ ‪.......................................‬‬
‫ﺑﻪ ﺷﻤﺎﺭﻩ ﺩﺍﻧﺸﺠﻮﻳﻲ ‪ ........................................‬ﺑﻪ ﺣﻀﻮﺭ ﺗﺴﻠﻴﻢ ﻣﻲ ﮔﺮﺩﺩ‪ .‬ﻟﺬﺍ ﻣﺴﺘﺪﻋﻲ ﺍﺳﺖ ﻧﺴﺒﺖ ﺑﻪ ﺗﺎﻳﻴﺪ ﺭﺳﻴﺪ ﻭ ﺛﺒﺖ ﺩﺭ ﺁﺭﺷﻴﻮ‬
‫ﻣﺮﺑﻮﻃﻪ ﺍﻗﺪﺍﻡ ﻻﺯﻡ ﻣﺒﺬﻭﻝ ﻓﺮﻣﺎﺋﻴﺪ‪.‬‬
‫ﺗﺎﺭﻳﺦ ﻭ ﺍﻣﻀﺎ ﺩﺍﻧﺸﺠﻮ‬

‫ﺍﺳﺘﺎﺩ ﻣﺤﺘﺮﻡ‬
‫ﺑﺎﺳﻼﻡ؛‬
‫ﮔﻮﺍﻫﻲ ﻣﻲ ﻧﻤﺎﻳﺪ‪ ،‬ﺑﺮﺍﺩﺭ‪ /‬ﺧﻮﺍﻫﺮ ‪ .......................................‬ﺑﻪ ﺷﻤﺎﺭﻩ ﺩﺍﻧﺸﺠﻮﻳﻲ ‪ ........................................‬ﮔﺰﺍﺭﺵ ﻛﺎﻣﻞ‬
‫ﻛﺎﺭﺁﻣﻮﺯﻱ ‪ /‬ﭘﺮﻭژﻩ ﺭﺍ ﺩﺭ ﺗﺎﺭﻳﺦ ‪ .......................‬ﺗﺤﻮﻳﻞ ﺍﻳﻦ ﻛﺘﺎﺑﺨﺎﻧﻪ ﻧﻤﻮﺩﻩ ﺍﺳﺖ ﻭ ﺍﻳﻦ ﻧﺴﺨﻪ ﺩﺭ ﺁﺭﺷﻴﻮ ﺛﺒﺖ ﻭ ﻧﮕﻬﺪﺍﺭﻱ ﺧﻮﺍﻫﺪ‬
‫ﺷﺪ‪.‬‬
‫ﻣﻬﺮ ﻭ ﺍﻣﻀﺎ ﻣﺴﺌﻮﻝ ﻛﺘﺎﺑﺨﺎﻧﻪ‬

‫ﻣﺴﺌﻮﻝ ﻣﺤﺘﺮﻡ ﺑﺎﻳﮕﺎﻧﻲ‬

‫ﺑﺎﺳﻼﻡ؛‬
‫ﭘﻴﺮﻭ ﺗﺎﻳﻴﺪﺍﺕ ﻓﻮﻕ ﻳﻚ ﻧﺴﺨﻪ ﮔﺰﺍﺭﺵ ﻛﺎﺭﺁﻣﻮﺯﻱ ﺩﺍﻧﺸﺠﻮ‪ ..........................................‬ﺑﻪ ﺷﻤﺎﺭﻩ ﺩﺍﻧﺸﺠﻮﺋﻲ ‪..................................‬‬
‫ﺑﺎ ﻧﻤﺮﻩ‪ .......................‬ﺟﻬﺖ ﺛﺒﺖ ﺩﺭ ﭘﺮﻭﻧﺪﻩ ﺁﻣﻮﺯﺷﻲ ﻧﺎﻣﺒﺮﺩﻩ ﺑﻪ ﺣﻀﻮﺭﺗﺎﻥ ﺍﺭﺳﺎﻝ ﻣﻴﮕﺮﺩﺩ‪ .‬ﻣﻘﺘﻀﻲ ﺍﺳﺖ ﺑﻌﺪ ﺍﺯ ﺗﺤﻮﻳﻞ‪ ،‬ﻧﺎﻣﻪ ﺭﺳﻴﺪ‬
‫ﺍﺭﺍﺋﻪ ﻓﺮﻣﺎﺋﻴﺪ‪.‬‬
‫ﺗﺎﺭﻳﺦ – ﺍﻣﻀﺎ ﺍﺳﺘﺎﺩ ﻣﺤﺘﺮﻡ‬

‫ﻣﺴﺌﻮﻝ ﻣﺤﺘﺮﻡ ﺩﻓﺘﺮ ﺍﺭﺗﺒﺎﻁ ﺑﺎ ﺻﻨﻌﺖ‬

‫ﺑﺎﺳﻼﻡ؛‬
‫ﺍﺣﺘﺮﺍﻣ ًﺎ ﭘﻴﺮﻭ ﺩﺭﻳﺎﻓﺖ ﻳﻚ ﻧﺴﺨﻪ ﺍﺯ ﮔﺰﺍﺭﺵ ﻧﺎﻣﺒﺮﺩﻩ ﻭ ﺭﺳﻴﺪ ﺍﺭﺍﺋﻪ ﺷﺪﻩ ﺑﻪ ﺷﻤﺎﺭﻩ‪ .................................‬ﺩﺭ ﺗﺎﺭﻳﺦ ‪ ......................‬ﺑﻪ‬
‫ﺍﺳﺘﺎﺩ ﻣﺤﺘﺮﻡ ﺁﻗﺎﻱ‪ /‬ﺧﺎﻧﻢ‪ ..............................‬ﻣﺮﺍﺗﺐ ﺑﻌﺪ ﺍﺯ ﺛﺒﺖ ﺟﻬﺖ ﺍﺳﺘﺤﻀﺎﺭ ﺑﻪ ﺣﻀﻮﺭ ﺍﺭﺳﺎﻝ ﻣﻲ ﮔﺮﺩﺩ‪.‬‬
‫ﺗﺎﺭﻳﺦ – ﺍﻣﻀﺎ ﻣﺴﺌﻮﻝ ﺑﺎﻳﮕﺎﻧﻲ‬