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Formulaire Inscription
Formulaire Inscription
ﺧــﺎﺹ ﺑﺎﻟﻤﺘﻌﻠــــﻢ
NOM : BRADJA ﺍﻟﻠﻘﺐ :ﺑﺮﺍﺟﺔ
PRENOM : MOHAMED ﺍﻹﺳﻢ :ﻣﺤﻤﺪ
ﺍﻟﻬﺎﺗﻒ 0670131445 : ﺗﺎﺭﻳﺦ ﻭ ﻣﻜﺎﻥ ﺍﻟﻤﻴﻼﺩ 1991-12-29 :ﺑــ :ﺍﻟﺤﻤﺎﺩﻧﺔ
ﺍﻟﻌﻨﻮﺍﻥ :ﺷﺎﺭﻉ ﻏﻴﻼﺱ ﻋﺎﺑﺪ ﺍﻟﺤﻤﺎﺩﻧﺔ
ﺍﻟﻮﻻﻳﺔ -ﺍﻟﺪﺍﺋﺮﺓ -ﺍﻟﺒﻠﺪﻳـــﺔ :ﻏﻴﻠﻴﺰﺍﻥ -ﻏﻠﻴﺰﺍﻥ -ﻏﻠﻴﺰﺍﻥ
ﻧﻮﻉ ﺍﻟﺪﺭﻭﺱ :ﺃﺭﺿﻴﺔ ﺍﻟﺘﻌﻠﻴﻢ ﺍﻹﻟﻜﺘﺮﻭﻧﻴ)ﻠﻠﻤﻌﻴﺪﻳﻦ( ﺍﻟﻤﺴﺘﻮﻯ ﻭ ﺍﻟﺸﻌﺒﺔ :ﺛﺎﻧﻴﺔ ﺛﺎﻧﻮﻱ ﻋﻠﻮﻡ ﺗﺠﺮﻳﺒﻴﺔ 214
ﺍﻟﺒﻜﺎﻟﻮﺭﻳﺎ /ﺷ.ﺘ.ﻢ :ﻻ ﻧﻮﻉ ﺍﻟﻄﺎﻟﺐ :ﻣﺘﻌﻠﻢ ﻋﺎﺩﻱ ﻫﻞ ﺃﻧﺖ ﻣﺴﺠﻞ ﺑﺜﺎﻧﻮﻳﺔ ﺃﻭ ﻣﺘﻮﺳﻄﺔ :ﻻ
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ﻣﻼﺣﻈﺔ:
ﺗﺼﺮﻳﺢ ﺷﺮﻓﻲ ﻳﻤﻀﻰ ﻣﻦ ﻃﺮﻑ ﺍﻟﻤﻌﻨﻲ ﻭ ﻳﺼﺎﺩﻕ ﻋﻠﻴﻪ ﻓﻲ ﺍﻟﺒﻠﺪﻳﺔ ،ﻭ ﻳﻘﺺ ﻭ ﻳﻮﺩﻉ ﻓﻲ ﺍﻟﻤﺮﻛﺰ ﺍﻟﻮﻻﺋﻲ ﻣﻊ ﻣﻠﻒ ﺍﻟﺘﺴﺠﻴﻞ.
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ﺗﺼﺮﻳﺢ ﺷﺮﻓﻲ