

-: ‫اﻟﻤﺴﺘﻨﺪات اﻟﻤﻄﻠﻮﺑﺔ‬
  
 
 
 
 
 
 

 -: ‫ﺗﻌﻠﯿﻤﺎت ﻋﺎﻣﺔ ﻟﻠﻄﻼب‬

 
 
 
 

 
 
 
 
 
 
 
 








 _____________________________________________________
 __________________________________________________

١
 ‫إﻗــــــــــــــــﺮار‬
________________________________-: ً‫أوﻻ‬
 
 
 
-:ً‫ﺛﺎﻧﯿﺎ‬

 
-:ً‫ﺛﺎﻟﺜﺎ‬


 
-: ً‫راﺑﻌ ﺎ‬


 
 -: ً‫ﺧﺎﻣﺴﺎ‬
-: ً‫ﺳﺎدﺳﺎ‬

 
 _________________________________________________________


 _________________________________________________________________
‫اﻟﺸﮭــــــــــــــــــــــــﻮد‬
 _________________________________________________________
 ____________________________________________
 _________________________________________________________________
 _________________________________________________________________
: ‫ﻋﻨﻮان اﻟﻄﺎﻟﺐ‬
 _____________________________________________________________________
 ______________________________________________________
______________________________________________________
 ____________________________________________________
 _______________________________________________________________

٢
 - : ‫ﻋﻨﻮان ﺳﻜﻦ اﻟﻄﺎﻟﺐ‬
 _________________________________________________________________
 _______________________________________________________________
 __________________________________________________________
 

‫إﻗﺮار ﻣﻦ وﻟﻲ أﻣﺮ اﻟﻄﺎﻟﺐ‬




 

 
 _______________________________________________________________
 ___________________________________________________________________
 _________________________________________________________
 ___________________________________________________________________
 ___________________________________________________________________

: ‫ﻣﻌﻠﻮﻣﺎت ﻋﻦ وﻟﻲ اﻷﻣﺮ‬

 _______________________________________________________________
 ___________________________________________________________
 _____________________________________________________________
 ____________________________________________________________________
 ________________________________________________________________
 _______________________________________________________________
 

٣
 

 _________________________________________
 _______________________

-: ‫اﻟﻤﺴﺘﻨﺪات اﻟﻤﻄﻠﻮﺑﺔ‬
  
 
 
 
 ________________________________________
 _______________________________________________
 ________________________________________________


 
 
 
 ____________________
 ____________________________

: ‫ﻣﻌﻠﻮﻣﺎت ﻋﻦ ﺛﻼﺛﺔ ﻣﻦ اﻷﻗﺎرب‬

 ______________________________________________
 __________________________________
 ______________________________________________
 __________________________________
 ______________________________________________
 __________________________________

١
 : ‫ﻣﻌﻠﻮﻣﺎت ﻋﻦ ﺛﻼﺛﺔ أﺷﺨﺎص ﯾﻌﺮﻓﻮﻧﻚ‬
 ______________________________________________
 __________________________________
 _______________________________________________


 __________________________________
 ______________________________________________


 __________________________________

: ‫ﺗﺰﻛﯿﺘﯿﻦ ﻣﻦ اﻟﺪﻛﺎﺗﺮة ﻓﻲ اﻟﻜﻠﯿﺔ‬

 _______________________
 _______________________

: ‫رأي اﻟﻠﺠﻨﺔ اﻟﻌﻠﻤﯿﺔ ﻓﻲ اﻟﻄﺎﻟﺐ‬

 ________________________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________

‫إﻗﺮار وﺗﻌﮭﺪ ﻣﻦ اﻟﻄﺎﻟﺐ‬

 


 

 
 
 
 
 

 