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‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻄﻠﺐ ‪:‬‬

‫ﻁﻠﺐ ﺗﻐﻄﻴــــﺔ ﺇﻋﻼﻣﻴــــــﺔ‬

‫‪..........................................................................................................................................................................................................‬‬ ‫‪:‬‬ ‫ﺍﻟﺠﻬﺔ ﺍﻟﻤﻨﻈﻤﺔ‬

‫‪..........................................................................................................................................................................................................‬‬ ‫‪:‬‬ ‫ﺗﻔﺎﺻﻴﻞ ﺍﻟﺤﺪﺙ‬

‫‪..........................................................................................................................................................................................................‬‬

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‫‪..........................................................................................................................................................................................................‬‬ ‫‪:‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﺤﺪﺙ‬

‫‪..........................................................................................................................................................................................................‬‬ ‫‪:‬‬ ‫ﺍﻟﻴــــــــــﻮﻡ‬

‫‪..........................................................................................................................................................................................................‬‬ ‫‪:‬‬ ‫ﺍﻟﺘﻮﻗﻴــــــﺖ‬

‫‪..........................................................................................................................................................................................................‬‬ ‫‪:‬‬ ‫ﻣﺪﺓ ﺍﻟﻔﻌﺎﻟﻴﺔ‬

‫‪..........................................................................................................................................................................................................‬‬ ‫‪:‬‬ ‫ﺍﻟﻤﻜــــــــﺎﻥ‬

‫ﻧﻮﻉ ﺍﻟﺘﻐﻄﻴﺔ‪:‬‬
‫ﺗﺼﻮﻳﺮ ﻓﻮﺗﻮﻏﺮﺍﻓﻲ‬ ‫ﻣﺮﺋﻴﺔ ﺗﻠﻔﺰﻳﻮﻧﻴﺔ‬
‫ﻣﺠﻠﺔ ﺍﻟﻤﻨﺒﺮ ﺍﻟﺠﺎﻣﻌﻲ‬ ‫ﺻﺤﻔﻴﺔ ﺇﺧﺒﺎﺭﻳﺔ‬

‫ﻣﺪﻯ ﺍﻷﻫﻤﻴﺔ‪:‬‬
‫ﻋﺎﺩﻱ‬ ‫ﻣﻬﻢ‬ ‫ﻣﻬﻢ ﺟﺪﺍ‬

‫‪.................................................................................‬‬ ‫‪ ، .................................................................................................. :‬ﺍﻟﻬﺎﺗﻒ ‪:‬‬ ‫ﻟﻠﺘﻨﺴﻴﻖ‪ ،‬ﺍﻻﺳﻢ‬

‫‪..........................................................................................................................................................................................................‬‬ ‫‪:‬‬ ‫ﺍﻟﻤﻼﺣﻈﺎﺕ‬

‫ﺧﺘﻢ ﻭﺗﻮﻗﻴﻊ‬
‫ﻣﻼﺣﻈﺔ ﻫﺎﻣﺔ‪ :‬ﻳﺮﺟﻰ ﺇﺭﺳﺎﻝ ﻁﻠﺐ ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺎﻟﻲ ﻗﺒﻞ ﺍﻟﻔﻌﺎﻟﻴﺔ ﺑﺄﺳﺒﻮﻉ‬
‫ﻣﻦ ﺗﺎﺭﻳﺨﻪ‪ ،‬ﺣﺘﻰ ﻳﺘﺴﻨﻰ ﻟﻨﺎ ﺍﺗﺨﺎﺫ ﺍﻹﺟﺮﺍءﺍﺕ ﺍﻟﻼﺯﻣﺔ‪.‬‬
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