‫اﶺﻬﻮرﯾﺔ اﳉﺰا ﺮﯾﺔ ا ﳝﻘﺮاﻃﯿﺔ اﻟﺸﻌﺒﯿﺔ‬

‫وزارة اﻟﺘﻌﻠﲓ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬

‫ﺎﻣﻌﺔ ﶊﺪ ﺑﻮﺿﯿﺎف ﳌﺴﯿ‬
‫ﳇﯿﺔ اﻟﻌﻠﻮم ﻗ ﺼﺎدﯾﺔ واﻟﺘ ﺎرﯾﺔ و ﻠﻮم اﻟ ﺴﯿﲑ‬
‫ﻗﺴﻢ ‪............................:‬‬

‫اﺳﺘﻤﺎرة ﺗﺴﺠﻴﻞ ﻣﺬﻛﺮة ﻣﺎﺳﺘﺮ ﻟﻠﺴﻨﺔ اﻟﺠﺎﻣﻌﻴــﺔ‪.............. /........... :‬‬

‫اﻻﺳﻢ و اﻟﻠﻘﺐ ‪............................................................................................. :‬‬

‫اﻟﻄﺎﻟﺐ اﻷول اﻟﻄﺎﻟﺐ اﻟﺜﺎﻧﻲ‬

‫ﺗﺎرﻳﺦ و ﻣﻜﺎن اﻟﻤﻴﻼد‪........................................................................................ :‬‬
‫رﻗﻢ اﻟﻬﺎﺗﻒ‪ .........................................:‬اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ‪.........................................:‬‬
‫اﻻﺳﻢ و اﻟﻠﻘﺐ ‪.............................................................................................. :‬‬
‫ﺗﺎرﻳﺦ وﻣﻜﺎن اﻟﻤﻴﻼد‪.......................................................................................... :‬‬
‫رﻗﻢ اﻟﻬﺎﺗﻒ‪ ........................................:‬اﻟﺒﺮﻳﺪاﻹﻟﻜﺘﺮوﻧﻲ‪..........................................:‬‬

‫ﻣﺎﺳﺘﺮ ﻣﻬﻨﻲ‬ ‫ﻣﺎﺳﺘﺮ أﻛﺎدﻳﻤﻲ‬ ‫اﻟﺸﻬﺎدة اﻟﻤﺤﻀﺮة‪:‬‬

‫اﻟﺸﻌﺒﺔ‪ ...........................................:‬اﻟﺘﺨﺼﺺ‪..........................................................:‬‬
‫ﻋﻨﻮان اﻟﻤﺬﻛﺮة‪.........................................................................................................:‬‬
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‫اﻹﺷﻜﺎﻟﻴﺔ اﻟﺮﺋﻴﺴﻴﺔ ‪.....................................................................................................:‬‬

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‫اﻟﺘﻮﻗﻴﻊ‬ ‫اﻟﺮﺗﺒﺔ‬ ‫اﻷﺳﺘﺎذ اﻟﻤﺸﺮف‬

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

‫ﻏﻴﺮ ﻣﻮاﻓﻖ‬ ‫ﻣﻮاﻓﻖ‬ ‫رأي اﻟﻠﺠﻨﺔ اﻟﻌﻠﻤﻴﺔ ‪:‬‬

‫ﻣﻼﺣﻈﺎت أو ﺗﺤﻔﻈﺎت‪...................................................................................................................:‬‬
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‫رﺋﻴﺲ اﻟﻘﺴﻢ‬ ‫ﻣﺴﺆول ﺷﻌﺒﺔ اﻟﺘﻜﻮﻳﻦ‬ ‫رﺋﻴﺲ اﻟﻠﺠﻨﺔ اﻟﻌﻠﻤﻴﺔ‬

‫ﺣﺮر ﺑﺘﺎرﻳﺦ ‪........./..../..... :‬‬

‫‪http://virtuelcampus.univ-msila.dz/facsegc‬‬ ‫ﳇﯿﺔ اﻟﻌﻠﻮم ﻗ ﺼﺎدﯾﺔ واﻟﺘ ﺎرﯾﺔ و ﻠﻮم اﻟ ﺴﯿﲑ‪ ،‬ﺎﻣﻌﺔ ﶊﺪ ﺑﻮﺿﯿﺎف ﳌﺴﯿ‬
‫‪https://www.facebook.com/Vice-Doyen-CEQLE-SEGC--Msila-475721049530765‬‬ ‫ص ب‪ 166 :‬اﳌﺴﯿ ‪ .28000‬اﳉﺰا ﺮ‪035 -35-33-33 : .‬‬