بﻟﺎطﻟﺎﺑ فﯾرﻌﺗﻟا:
/___/___/___/___/___/___/___/___/ : ﺔﯿﻨطﻮﻟا ﻒﯾﺮﻌﺘﻟا ﺔﻗﺎﻄﺑ ﻢﻗر
: ﻢﺳﻻا.............................................................: ﺐﻘﻠﻟا....................................................................................................
: ﺎﮭﻧﺎﻜﻣ /_________/___/___/___/___/ : ةدﻻﻮﻟا ﺦﯾرﺎﺗ....................................................................................................
: رﺎﻘﻟا ناﻮﻨﻌﻟا...............................................................................................................................................................
: ﺔﻨﯾﺪﻤﻟا ....................................................: يﺪﯾﺮﺒﻟا ﻢﯿﻗﺮﺘﻟا ......................................: ﻒﺗﺎﮭﻟا..........................................
ﺎﯾروﻟﺎﻛﺎﺑﻟا:
: ﺎﮭﯿﻠﻋ لﻮﺼﺤﻟا ﺔﻨﺳ.....................................ﺔﺒﻌﺸﻟا :.......................................................لﺪﻌﻤﻟا :.......................................
ﺎﯾروﻟﺎﻛﺎﺑﻟا دﻌﺑ ﻲﺳاردﻟا رﺎﺳﻣﻟا:
ﺔﯿﻌﻣﺎﺠﻟا ﺔﻨﺴﻟاﺔﺴﺳﺆﻤﻟاﻲﺳارﺪﻟا ىﻮﺘﺴﻤﻟاﺔﺒﻌﺸﻟاﺔﺠﯿﺘﻨﻟا
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(*):بوﻠطﻣﻟا ﺔﺳاردﻟا ىوﺗﺳﻣ
: ﺔﺜﻟﺎﺛ ﺔﻨﺳ : ﺔﯿﻧﺎﺛ ﺔﻨﺳ : ﻰﻟوأ ﺔﻨﺳ
:ﺔﺑﻮﻠﻄﻤﻟا ﺔﺴﺳﺆﻤﻟا.................................................................................................................................
:ﺔﺑﻮﻠﻄﻤﻟا ﺔﺒﻌﺸﻟا..............................................................................................................................
ﻲﺤﺻ : ﺔﻠﻘﻨﻟا ﺐﻠط ﺐﺒﺳﻲﻋﺎﻤﺘﺟا
ﻻ ﻢﻌﻧ : ﺔﯿﺒﯾدﺄﺗ ﺔﺑﻮﻘﻌﻟ ضﺮﻌﺘﻟا ﻖﺒﺳ ﻞھ
: ﺔﺑﻮﻘﻌﻟا عﻮﻧ.........................................................................................
ةرﻮﻛﺬﻤﻟا تﺎﻣﻮﻠﻌﻤﻟا ﺔﺤﺼﺑ فﺮﺸﻟا ﻰﻠﻋ حﺮﺻأ
............. ﻲﻓ..........
(ة)ﺐﻟﺎﻄﻟا ءﺎﻀﻣإ
: ﺔﻌﻣﺎﺟﻟا رارﻗ ﺔﻘﻓاوﻣﻟا ﺔﻘﻓاوﻣﻟا مدﻋ
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(*)) ﺔﻣﻼﻋ ﻊﺿ : x.ﺔﺑﺳﺎﻧﻣﻟا ﺔﻧﺎﺧﻟا ﻲﻓ (
اذھ فﻠﺧ رظﻧأ
صﺎﺻﺗﺧﻻا سﻔﻧ ﻲﻓ ﺔﯾﻌﻣﺎﺟ ﺔﻠﻘﻧ بﻠطﻣ
ﺔﯾﻌﻣﺎﺟﻟا ﺔﻧﺳﻟا2024/2025
18
-2.
2.
04
-0
ﺔﯾﻣﻠﻌﻟا ﺔﻛارﺷﻟاو ﺔﯾﻣﯾدﺎﻛﻷا نوؤﺷﻟا ةرادإ
تارظﺎﻧﻣﻟاو تﺎﻧﺎﺣﺗﻣﻻاو ﺞﻣارﺑﻟا ﺔﺣﻠﺻﻣ
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