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‫ن‬ ‫�‬

‫اللبناي لکرة القدم‬


‫ي‬ ‫ا��اد‬
‫‪Lebanese Football Association‬‬

‫ﺍﻟﺪﺍﺋﺮﺓ ﺍﻟﻔﻨﻴﺔ ‪ /‬ﻗﺴﻢ ﺍﻟﺘﺪﺭﻳﺐ ﻭﺍﻟﺘﻄﻮﻳﺮ‬

‫‪Personal Information:‬‬ ‫ﻣﻌﻠﻮﻣﺎﺕ ﺷﺨﺼﻴﺔ‬

‫‪Name:‬‬ ‫ﺍﻻﺳــــــــــــﻢ‪:‬‬

‫‪Nationality:‬‬ ‫ﺍﻟﺠــﻨــــﺴــﻴﺔ‪:‬‬

‫‪Phone No.:‬‬ ‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ‪:‬‬

‫‪E-mail:‬‬ ‫ﺍﻟﺒﺮﻳﺪ ﺍﻻﻟﻜﺘﺮﻭﻧﻲ‪:‬‬

‫‪Qualification:‬‬ ‫ﺍﻟﺘﺤﺼﻴﻞ ﺍﻟﻌﻠﻤﻲ‪:‬‬

‫‪Position:‬‬ ‫ﺍﻟﺼﻔﺔ‪:‬‬ ‫‪Club:‬‬ ‫ﺍﻟﻨﺎﺩﻱ‪:‬‬

‫‪Date of Birth:‬‬ ‫‪------/------/------‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻮﻻﺩﺓ‪:‬‬ ‫‪Size:‬‬ ‫ﺍﻟﻘﻴﺎﺱ‪:‬‬

‫‪Course place:‬‬ ‫ﻣﻜﺎﻥ ﺍﻟﺪﻭﺭﺓ‪:‬‬ ‫‪Course Level:‬‬ ‫ﻣﺴﺘﻮﻯ ﺍﻟﺪﻭﺭﺓ‪:‬‬

‫‪Sports Experience as a player:‬‬ ‫ﺍﻟﺨﺒﺮﺍﺕ ﺍﻟﺮﻳﺎﺿﻴﺔ ﻛﻼﻋﺐ‪:‬‬

‫ﺍﻟﻤﻮﺳﻢ‬ ‫ﺍﻟﻔﺌﺔ‬ ‫ﺍﻟﻔﺮﻳﻖ‬

‫‪١‬‬

‫‪٢‬‬

‫‪٣‬‬

‫‪Sports Experience as a coach:‬‬ ‫ﺍﻟﺨﺒﺮﺍﺕ ﺍﻟﺮﻳﺎﺿﻴﺔ ﻛﻤﺪﺭﺏ‪:‬‬

‫ﺍﻟﻤﻮﺳﻢ‬ ‫ﺍﻟﻔﺌﺔ‬ ‫ﺍﻟﻔﺮﻳﻖ‬

‫‪١‬‬

‫‪٢‬‬

‫‪٣‬‬

‫ﺗﻮﻗﻴﻊ ﻣﻘﺪﻡ ﺍﻟﻄﻠﺐ‪Requester Signature:____________________________:‬‬

‫ﺧﺎﺹ ﺑﺎﻟﺪﺍﺋﺮﺓ ﺍﻟﻔﻨﻴﺔ ‪ /‬ﻗﺴﻢ ﺍﻟﺘﺪﺭﻳﺐ ﻭﺍﻟﺘﻄﻮﻳﺮ ‪Specific for Technical Department / Coaching & Development‬‬

‫ﺍﻷﺳﺒﺎﺏ‪___________________________________________:‬‬ ‫ﻋﺪﻡ ﺍﻟﻤﻮﺍﻓﻘﺔ‬ ‫ﻣﻮﺍﻓﻘﺔ‬

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