‫اﺳﺗﻣﺎرة اﻟﻣﻌﻠوﻣﺎت‬

‫ﺟزء ﺧﺎص ﺑﺎﻟﺗﻠﻣﯾذ‬

‫‪ .......................................................‬اﻟﻠﻘب‪ :‬ﺑﺮﺍﺡ‬
‫‪.......................................................‬‬ ‫اﻻﺳم‪ :‬ﺷﻴﻤﺎﺀ‬
‫‪NOM:………………………………………………………………………………...‬‬
‫‪berrah‬‬
‫‪PRENOM: …………………………………………………….…………………….‬‬
‫‪chaima‬‬
‫‪...................................................................................................................‬‬
‫‪12/02/2007‬‬ ‫ﺗﺎرﯾﺦ اﻟﻣﯾﻼد‪:‬‬
‫اﻟﺷﻌﺑﺔ‪ :‬ﻋﻠﻮﻡ ﺗﺠﺮﻳﺒﺔ‬
‫‪......................................................‬‬ ‫اﻟﻣﺳﺗوى اﻟدراﺳﻲ‪ :‬ﺍﻟﺴﻨﺔ ﺍﻟﺜﺎﻟﺜﻪ‬
‫‪.........................................‬‬
‫‪............................................................................................................‬‬
‫ﺳﻜﻔﺎﻟﻲ ﻣﺤﻤﺪ‬ ‫اﻟﻣؤﺳﺳﺔ اﻟﺗﻌﻠﯾﻣﯾﺔ‪:‬‬
‫‪............................................................................................................‬‬
‫‪0561872413‬‬ ‫رﻗم اﻟﮭﺎﺗف اﻟﺟوال‪:‬‬
‫‪..............................................................................................................‬‬
‫‪chaimaberrah31@gmail.come‬‬ ‫اﻟﺑرﯾد اﻻﻟﻛﺗروﻧﻲ‪:‬‬

‫ﺟزء ﺧﺎص ﺑﺎﻟوﻟﻲ‬

‫‪ .......................................................‬اﻟﻠﻘب‪ :‬ﺑﺮﺍﺡ‬
‫‪......................................................‬‬ ‫اﻻﺳم‪ :‬ﺯﻫﻴﺮ‬
‫‪NOM:…………………………………………………………………………………...‬‬
‫‪berrah‬‬
‫‪PRENOM:…………………………………………….………………………………..‬‬
‫‪Zahir‬‬
‫رﻗم اﻟﮭﺎﺗف اﻟﺛﺎﺑت‪............................................................................................................. :‬‬
‫‪............................................................................................................‬‬
‫‪0561686545‬‬ ‫رﻗم اﻟﮭﺎﺗف اﻟﺟوال‪:‬‬
‫اﻟﺑرﯾد اﻻﻟﻛﺗروﻧﻲ‪berrah.zahir@yahoo.fr ......................... :‬‬
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‫اﻟﻣواد اﻟﺗﻲ ﺗرﻏب ﻓﻲ دراﺳﺗﮭﺎ‪:‬‬

‫ﺭﻳﺎﺿﻴﺎﺕ ﻭ ﻓﻴﺰﻳﺎﺀ ﺧﺎﻟﺪﻱ ﺍﻟﻌﻤﺮﻱ ﻋﻠﻮﻡ ﺍﻟﻄﺒﻴﻌﺔ ﻭﺍﻟﺤﻴﺎﻩ ﺑﻦ ﺩﺍﺩﺓ ﻣﺴﻌﻮﺩ‬

‫‪-2‬ﺻﻮرة ﻟﺒﻄﺎﻗﺔ اﻟﺘﻌﺮﯾﻒ اﻟﻮطﻨﯿﺔ اﻟﺒﯿﻮ ﻣﺘﺮﯾﺔ‬ ‫‪-1‬ﺻﻮرة ﺷﻤﺴﯿﺔ ﺣﺪﯾﺜﺔ ﺑﺨﻠﻔﯿﺔ ﺑﯿﻀﺎء‬ ‫اﻟوﺛﺎﺋﻖ اﻟﻣطﻠوﺑﺔ‪:‬‬
‫‪-4‬اﺳﺘﻤﺎرة اﻟﻤﻌﻠﻮﻣﺎت‬ ‫‪-3‬ﺷﮭﺎدة ﻣﺪرﺳﯿﺔ أو ﻛﺸﻒ ﻧﻘﺎط اﻟﻔﺼﻞ اﻟﺜﺎﻟﺚ‬
‫‪ -5‬اﻟﻘﺎﻧﻮن اﻟﺪاﺧﻠﻲ ﻟﻠﻤﺪرﺳﺔ ﯾﺤﻤﻞ و ﯾﻄﺒﻊ ﻣﻊ ﻣﻞء اﻟﻤﻌﻠﻮﻣﺎت اﻟﺨﺎﺻﺔ و اﻻﻣﻀﺎء‬