‫اﻟﺟﻣﮭورﯾﺔ اﻟﺟزاﺋرﯾﺔ اﻟدﯾﻣﻘراطﯾﺔ اﻟﺷﻌﺑﯾﺔ‬ ‫اﻟﺟﻣﮭورﯾﺔ اﻟﺟزاﺋرﯾﺔ اﻟدﯾﻣﻘراطﯾﺔ اﻟﺷﻌﺑﯾﺔ‬

‫اﻟدﯾوان اﻟوطﻧﻲ ﻟﻠﺧدﻣﺎت اﻟﺟﺎﻣﻌﯾـﺔ‬ ‫اﻟدﯾوان اﻟوطﻧﻲ ﻟﻠﺧدﻣﺎت اﻟﺟﺎﻣﻌﯾـﺔ‬

‫اﻟﺻورة‬ ‫ﻣدﯾرﯾـﺔ اﻟﺧدﻣﺎت اﻟﺟﺎﻣﻌﯾﺔ ‪.‬ﺳﻌﯾـدة‬ ‫ﻣدﯾرﯾـﺔ اﻟﺧدﻣﺎت اﻟﺟﺎﻣﻌﯾﺔ ‪.‬ﺳﻌﯾـدة‬
‫اﻹﻗﺎﻣﺔ اﻟﺟﺎﻣﻌﯾﺔ اﻟﺻوﻣﺎم ‪.‬ﺳﻌﯾدة‬
‫اﻟﺻورة‬ ‫اﻹﻗﺎﻣﺔ اﻟﺟﺎﻣﻌﯾﺔ اﻟﺻوﻣﺎم ‪.‬ﺳﻌﯾدة‬

‫اﺳﺗﻣــﺎرة طﻠب اﻹﯾــواء ‪2023/2022‬‬ ‫اﺳﺗﻣــﺎرة طﻠب اﻹﯾــواء ‪2023/2022‬‬

‫اﻟﻠﻘﺐ ‪ ...........................................................:‬ﺳﻢ ‪..........................................................:‬‬ ‫اﻟﻠﻘﺐ ‪ ...........................................................:‬ﺳﻢ ‪..........................................................:‬‬
‫ﺗﺎر ﺦ اﳌﻴﻼد‪ .....................................................:‬ﺑ ـ‪.................................................................:‬‬ ‫ﺗﺎر ﺦ اﳌﻴﻼد‪ .....................................................:‬ﺑ ـ‪.................................................................:‬‬
‫اﺳﻢ ب ‪ ..................................:‬ﻟﻘﺐ واﺳﻢ م ‪..............................................................:‬‬ ‫اﺳﻢ ب ‪ ..................................:‬ﻟﻘﺐ واﺳﻢ م ‪..............................................................:‬‬
‫‪ ............................................................:‬اﻟﻮﻻﻳﺔ‪......................................:‬‬ ‫اﻟﻌﻨﻮان اﻟ‬ ‫‪ ............................................................:‬اﻟﻮﻻﻳﺔ‪......................................:‬‬ ‫اﻟﻌﻨﻮان اﻟ‬
‫اﳌﺴﺘﻮى‪ ....................:‬اﻟﺸﻌﺒﺔ‪.............................................................................................:‬‬ ‫اﳌﺴﺘﻮى‪ ....................:‬اﻟﺸﻌﺒﺔ‪.............................................................................................:‬‬
‫ا ﻨﺎح ‪ .....................:‬رﻗﻢ اﻟﻐﺮﻓﺔ ‪......................................................................................:‬‬ ‫ا ﻨﺎح ‪ .....................:‬رﻗﻢ اﻟﻐﺮﻓﺔ ‪......................................................................................:‬‬
‫ﺳﻨﺔ ا ﺼﻮل ﻋ ﺷ ﺎدة اﻟﺒ ﺎﻟﻮر ﺎ ‪ ...........................:‬ﻓﺼﻴﻠﺔ اﻟﺪم‪.............................:‬‬ ‫ﺳﻨﺔ ا ﺼﻮل ﻋ ﺷ ﺎدة اﻟﺒ ﺎﻟﻮر ﺎ ‪ ...........................:‬ﻓﺼﻴﻠﺔ اﻟﺪم‪.............................:‬‬
‫ﻴﻞ ﺑﺎﻹﻗﺎﻣﺔ ا ﺎﻣﻌﻴﺔ اﻟﺼﻮﻣﺎم‬ ‫ﻣﺮاﺣﻞ اﻟ‬ ‫ﻴﻞ ﺑﺎﻹﻗﺎﻣﺔ ا ﺎﻣﻌﻴﺔ اﻟﺼﻮﻣﺎم‬ ‫ﻣﺮاﺣﻞ اﻟ‬
‫اﻟﻣرﺣﻠﺔ اﻟﺛﺎﻟﺛﺔ‬ ‫اﻟﻣرﺣﻠﺔ اﻟﺛﺎﻧﯾﺔ‬ ‫اﻟﻣرﺣﻠﺔ اﻷوﻟﻰ‬ ‫اﻟﻣرﺣﻠﺔ اﻟﺛﺎﻟﺛﺔ‬ ‫اﻟﻣرﺣﻠﺔ اﻟﺛﺎﻧﯾﺔ‬ ‫اﻟﻣرﺣﻠﺔ اﻷوﻟﻰ‬
‫اﻟﺟﻧﺎح واﻟﻐرﻓﺔ‬ ‫اﻟﻔﺣص اﻟطﺑﻲ‬ ‫ﻣﻠف اﻟﺗﺳﺟﯾل‬ ‫اﻟﺟﻧﺎح واﻟﻐرﻓﺔ‬ ‫اﻟﻔﺣص اﻟطﺑﻲ‬ ‫ﻣﻠف اﻟﺗﺳﺟﯾل‬

‫اﻟﻣرﺣﻠﺔ اﻟﺳﺎدﺳﺔ‬ ‫اﻟﻣرﺣﻠﺔ اﻟﺧﺎﻣﺳﺔ‬ ‫اﻟﻣرﺣﻠﺔ اﻟراﺑﻌﺔ‬ ‫اﻟﻣرﺣﻠﺔ اﻟﺳﺎدﺳﺔ‬ ‫اﻟﻣرﺣﻠﺔ اﻟﺧﺎﻣﺳﺔ‬ ‫اﻟﻣرﺣﻠﺔ اﻟراﺑﻌﺔ‬
‫اﻹﯾــــــــــواء‬ ‫اﻟﺑطﺎﻗﺔ اﻟﻣﻐﻧﺎطﯾﺳﯾﺔ‬ ‫اﻟﺑﯾﺎﺿﺔ )اﻟﻔراش(‬ ‫اﻹﯾــــــــــواء‬ ‫اﻟﺑطﺎﻗﺔ اﻟﻣﻐﻧﺎطﯾﺳﯾﺔ‬ ‫اﻟﺑﯾﺎﺿﺔ )اﻟﻔراش(‬

‫اﻟﻣﻛﻠف ﺑﻣﺻﻠﺣﺔ اﻹﯾواء‬ ‫إﻣﺿﺎء اﻟطﺎﻟﺑﺔ‬ ‫اﻟﻣﻛﻠف ﺑﻣﺻﻠﺣﺔ اﻹﯾواء‬ ‫إﻣﺿﺎء اﻟطﺎﻟﺑﺔ‬