‫اﻟﺠﻤﮭﻮرﯾﺔ اﻟﺘﻮﻧﺴﯿﺔ‬

‫ﺑﻄﺎﻗﺔ إرﺷﺎدات‬
‫وزارة اﻟﺘﻌﻠﯿﻢ اﻟﻌﺎﻟﻲ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬

‫‪PHOTO‬‬ ‫ﺟﺎﻣﻌﺔ ﺗﻮﻧﺲ‬

‫‪INFORMATION‬‬
‫‪University of Tunis‬‬
‫‪FORM‬‬ ‫اﻟﻤﻌﮭﺪ ال‍ع‍‍الي لل‍‍أعمال ب‍ت‍‍ونس‬
‫‪Tunis Business School‬‬
‫‪2021/2022‬‬

‫اﻟﺮﺟﺎء ﺘﻌﻤﯿﺮ ھﺬه اﻟﺒﻄﺎﻗﺔ بدقة‬

‫‪Please complete this form accurately‬‬

‫اﻟﺸﮭﺎدة التي تفضي إليها الدراسة الحالية……‪Final Diploma ……………………..............................….............‬‬

‫‪ ..................................................................................................................‬المستوى الدراسي ‪Level‬‬

‫‪Professional Master NGOs‬‬ ‫□‬ ‫‪Research Master‬‬ ‫ماجستير بحث □ ماجستير مهني □ □‬
‫دكتوراه ‪)Doctorate (PhD ........................‬‬
‫هل تحصلت على منحة في إطار التبادل العلمي الدولي للسنة الجامعية ‪2021/2022‬‬
‫‪Are you Currently on an exchange Program for the academic year 2021/2022‬‬

‫‪CIN Number‬‬ ‫□□□□□□□□□□□□□□‬ ‫ﺑﻄﺎﻗﺔ ﺗﻌﺮﯾﻒ وﻃﻨﯿﺔ‬

‫اﻹﺳﻢ………………………………………………‪First Name ..………........................................‬‬

‫اﻟﻠﻘﺐ………………………………‪Last Name……………………………………………………....................‬‬
‫ﺗﺎرﯾﺦ اﻟﻮﻻدة‪Date of Birth…………………………………………………...................................................…...‬‬

‫‪Gender :‬‬ ‫‪M‬‬ ‫□‬ ‫‪F‬‬ ‫□‬ ‫□‬ ‫ذﻛﺮ ‪:‬اﻟﺠﻨﺲ‬ ‫أﻧﺜﻰ□‬

‫ﻣﻜﺎن اﻟﻮﻻدة‪Place of birth…………………………………………………………............…………………….‬‬

‫‪ …...................................…………………………………………………………………………………………………………..‬اﻟﻤﺪﻧﯿﺔ اﻟﺤﺎﻟﺔ ‪Civil Status‬‬
‫اﻟﺠﻨﺴﯿﺔ بالنسبة إلى الطلبة األﺟﺎﻧﺐ‪Nationality for foreign students……………………….............................…….‬‬

‫‪Passport number for foreign students‬‬ ‫رﻗﻢ جواز السفر بالنسبة إلى الطلبة اﻷﺟﺎﻧﺐ □□□□□□□□□□‬
‫?‪Did you get vaccinated ‬‬ ‫□ ‪Yes‬‬ ‫□ ‪No‬‬ ‫ال□ نعم هل قمت بالتلقيح ؟ □‬
‫أي نوع من اللقاح ؟ ‪Which type of vaccine ?……………………….‬‬
‫‪Master or Bachelor or Licence / degree or equivalent diploma‬‬ ‫اﻟﺒﻛﺎﻟﻮرس أو اإلجازة أو الماجستير‬

‫‪Year‬‬ ‫□□□□‬ ‫السنة‬

Session ………………… ‫اﻟﺪورة‬Year □□□□ ‫ﺳﻨﺔ اﻟﺒﺎﻛﺎﻟﻮرﯾﺎ‬

Mention …….........……………. ‫اﻟﻤﻼﺣﻈﺔ‬ Section........................……..‫اﻟﺸﻌﺒﺔ‬

Country of Issue …………………………………………………………………………………………………..…………………………………‫اﻟﺒﻠﺪ‬

 About the Student
‫خاص باﻟﻄﺎﻟﺐ‬

Street Address ‫اﻟﻌﻨﻮان‬

ZIP Code ................................................ ‫اﻟﺘﺮﻗﯿﻢ اﻟﺒﺮﯾﺪي‬ City / Town of residence ‫اﻟﻤﺪﯾﻨﺔ‬
Governorate ‫اﻟﻮﻻﯾﺔ‬
Email Address………………………………………………………………………………….… ‫اﻟﻌﻨﻮان اﻹﻟﻜﺘﺮوﻧﻲ‬
...................................................................................................................................... Phone Number ‫اﻟﮭﺎﺗﻒ اﻟﺠﻮال‬

Information about the student’s Father

‫معلومات حول اﻷب‬

………………………………………………………………………………………………… First Name‫اﻹﺳﻢ‬

Profession …………………………………………….……………………………………….………… ‫اﻟﻤﮭﻨﺔ‬
Phone number ………..…………………………………..........................……………..(‫اﻟﺠﻮال واﻟﻘﺎر) رﻗﻢ اﻟﮭﺎﺗﻒ‬

Information about the Student’s Mother

‫معلومات حول اﻷم‬

………………………………………………………………………………………………… First Name‫اﻹﺳﻢ‬

Profession …………………………………………………………………………………………..….. ‫اﻟﻤﮭﻨﺔ‬
Phone number …………..…………………………..………………………….….... (‫اﻟﺠﻮال واﻟﻘﺎر) رﻗﻢاﻟﮭﺎﺗﻒ‬

Parents’ Address ‫اﻟﻌﻨﻮان اﻟﻌﺎﺋﻠﻲ‬

Street Address ‫اﻟﻌﻨﻮان‬

ZIP Code ................................................ ‫اﻟﺘﺮﻗﯿﻢ اﻟﺒﺮﯾﺪي‬ City of residence ‫اﻟﻤﺪﯾﻨﺔ‬
Governorate ‫اﻟﻮﻻﯾﺔ‬
Email Address……………………………………………………………………………………… ‫اﻟﻌﻨﻮان اﻹﻟﻜﺘﺮوﻧﻲ‬
Phone Number ...................................................................................................................................‫اﻟﺠﻮال رﻗﻢ اﻟﮭﺎﺗﻒ‬
Other Address ‫ﻋﻨﻮان آﺧﺮ‬

………………………………………………………………………………………………… First Name‫اﻹﺳﻢ‬

Profession ……………………………………………………………………………... ‫اﻟﻤﮭﻨﺔ‬
Phone number .....................……………………………….....………………….….. (‫ اﻟﻘﺎر) رﻗﻢ اﻟﮭﺎﺗﻒ‬ ‫واﻟﺠﻮال‬