‫اﻷﺳﺘﺎذ )ة(‪...................................... :‬‬ ‫اﻷﻛﺎدﻳﻤﻴﺔ اﻟﺠﻬﻮﻳﺔ‪..............................

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‫رﻗﻢ اﻟﺘﺄﺟﺮﻴ‪............................... :‬‬ ‫اﻟﻤﺪﻳﺮﻳﺔ اﻹﻗﻠﻴﻤﻴﺔ‪...............................:‬‬
‫اﻟﻤﺴﺘﻮ￯ ‪ :‬اﻷول اﺑﺘﺪاﻲﺋ‬ ‫ﻣﻘﺮ اﻟﻌﻤﻞ ‪...............................................:‬‬
‫اﻟﻤﺎدة‪ :‬اﻟﻠﻐﺔ اﻟﻌﺮﺑﻴﺔ‬
‫اﻟﻤﻮﺳﻢ اﻟﺪراﻲﺳ‪        :‬‬
‫اﻟﻤﺮﺟﻊ ‪ :‬اﻟﻤﻔﻴﺪ ﻲﻓ اﻟﻠﻐﺔ اﻟﻌﺮﺑﻴﺔ‬

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‫ﺗﻮﻗﻴﻊ اﻟﻤﻔﺘﺶ) ة‬ ‫ﺗﻮﻗﻴﻊ اﻟﻤﺪﻳﺮ )ة(‬ ‫ﺗﻮﻗﻴﻊ اﻷﺳﺘﺎذ )ة(‬

‫اﻷﺳﺘﺎذ‪...................................... :‬‬ ‫اﻷﻛﺎدﻳﻤﻴﺔ اﻟﺠﻬﻮﻳﺔ‪.............................. :‬‬
‫رﻗﻢ اﻟﺘﺄﺟﺮﻴ‪............................... :‬‬ ‫اﻟﻤﺪﻳﺮﻳﺔ اﻹﻗﻠﻴﻤﻴﺔ‪...............................:‬‬
‫اﻟﻤﺴﺘﻮ￯ ‪ :‬اﻷول اﺑﺘﺪاﻲﺋ‬ ‫ﻣﻘﺮ اﻟﻌﻤﻞ ‪...............................................:‬‬
‫اﻟﻤﺎدة‪ :‬اﻟﻠﻐﺔ اﻟﻌﺮﺑﻴﺔ‬
‫اﻟﻤﻮﺳﻢ اﻟﺪراﻲﺳ‪        :‬‬
‫اﻟﻤﺮﺟﻊ ‪ :‬اﻟﻤﻔﻴﺪ ﻲﻓ اﻟﻠﻐﺔ اﻟﻌﺮﺑﻴﺔ‬

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‫ﺗﻮﻗﻴﻊ اﻟﻤﻔﺘﺶ) ة‬ ‫ﺗﻮﻗﻴﻊ اﻟﻤﺪﻳﺮ )ة(‬ ‫ﺗﻮﻗﻴﻊ اﻷﺳﺘﺎذ )ة(‬