‫وزارة اﻟﺗﻌﻠﯾم اﻟﻌﺎﻟﻲ واﻟﺑﺣث اﻟﻌﻠﻣﻲ‬

‫اﺳﺗﻣﺎرة اﻟﺗﺳﺟﯾل اﻷوﻟﻲ وإﻋﺎدة اﻟﺗﺳﺟﯾل ﻓﻲ دﻛﺗوراه ﻋﻠوم‬

‫ﺑﻣﻘﺗﺿﻰ اﻟﻣرﺳوم رﻗم ‪ 254 /98‬اﻟﻣؤرخ ﻓﻲ ‪17‬أوت ‪ 1998‬اﻟﻣﺗﻌﻠق ﺑﺎﻟﺗﻛوﯾن ﻓﻲ اﻟدﻛﺗوراه و ﻣﺎﺑﻌد اﻟﺗدرج اﻟﻣﺗﺧﺻص و اﻟﺗﺄھﯾل‬
‫اﻟﺟﺎﻣﻌﻲ اﻟﻣﻌدل و اﻟﻣﺗﻣم‪.‬اﻟﺳﻧﺔ اﻟﺟﺎﻣﻌﯾﺔ‪2020/2019 :‬‬
‫ﻛﻠﯾﺔ‪/‬ﻣﻌﮭد‪:‬ﻛﻠﯾﺔ اﻟﻌﻠوم اﻻﻗﺗﺻﺎدﯾﺔ و اﻟﻌﻠوم اﻟﺗﺟﺎرﯾﺔ و ﻋﻠوم اﻟﺗﺳﯾﯾر‬

‫اﻟﻘﺳم‪:‬ﻋﻠوم إﻗﺗﺻﺎدﯾﺔ‪ ،‬ﻋﻠوم ﺗﺟﺎرﯾﺔ‪،‬ﻋﻠوم اﻟﺗﺳﯾﯾر‬

‫اﻟﺷﻌﺑﺔ‪ :‬ﻋﻠوم إﻗﺗﺻﺎدﯾﺔ‪ ،‬ﻋﻠوم ﺗﺟﺎرﯾﺔ‪،‬ﻋﻠوم اﻟﺗﺳﯾﯾر و ﻋﻠوم ﻣﺎﻟﯾﺔ و ﻣﺣﺎﺳﺑﺔ‬

‫اﻟﺗﺧﺻص‪......................................................:‬‬
‫ﺳﻧﺔ اﻟﺑﻛﺎﻟورﯾﺎ‪ ....................:‬رﻗم اﻟﺑﻛﺎﻟورﯾﺎ ‪ /...................:‬رﻗم ﺑطﺎﻗﺔ اﻟﺗﻌرﯾف اﻟوطﻧﯾﺔ‪............:‬‬

‫اﻟﻠﻘب‪Nom : ... ......................................./ ..............................................:‬‬

‫اﻹﺳم‪Prénom ............................................../.............................................:‬‬

‫ﺗﺎرﯾﺦ اﻻزدﯾﺎد‪ ......../......../....:‬ﻣﻛﺎن اﻟﻣﯾﻼد‪ ..........................:‬اﻟوﻻﯾﺔ‪.................:‬‬

‫إﺳم اﻻب‪................................:‬ﻟﻘب وإﺳم اﻷم‪.................................:‬‬

‫اﻟﺟﻧس‪ ..............................:‬اﻟﺟﻧﺳﯾﺔاﻷﺻﻠﯾﺔ‪............................................:‬‬

‫اﻟﻌﻧوان اﻟﺷﺧﺻﻲ‪..................................................................................................:‬‬

‫اﻟﺑرﯾد اﻻﻟﻛﺗروﻧﻲ‪.......................................................:‬‬ ‫رﻗم اﻟﮭﺎﺗف‪.........................:‬‬

‫وﻻﯾﺔ اﻹﻗﺎﻣﺔ اﻟﺣﺎﻟﯾﺔ‪....................................:‬‬

‫وظﯾﻔﺔ أﺧرى‬ ‫أو‬ ‫اﻟوظﯾﻔﺔ‪:‬أﺳﺗﺎذ‬

‫ﺗﺎرﯾﺦ أول ﺗﺳﺟﯾل ﻓﻲ اﻟدﻛﺗوراه‪............/............:‬‬

‫ﻋﻧوان اﻻطروﺣﺔ‪................................................................................................... :‬‬

‫إﺳم اﻟﻣﺷرف‪ ..........................:‬اﻣﺿﺎء اﻟﻣﺷرف‪.......................:‬‬

‫اﻟدرﺟﺔ اﻟﻌﻠﻣﯾﺔ‪ ........................:‬اﻟﻣؤﺳﺳﺔ اﻷﺻﻠﯾﺔ‪......................:‬‬

‫إﻣﺿﺎء ﻧﯾﺎﺑﺔ رﺋﺎﺳﺔ اﻟﺟﺎﻣﻌﺔ‬ ‫إﻣﺿﺎء اﻟﻌﻣﯾد‬ ‫إﻣﺿﺎء رﺋﯾس اﻟﻘﺳم‬ ‫إﻣﺿﺎء اﻟطﺎﻟب‬

‫ﻣﻼﺣظﺔ‪ :‬ﻣلء اﻟﻣﻌﻠوﻣﺎت اﻟﻣدوﻧﺔ أ ﻋﻼه إﺟﺑﺎري‪.‬‬