‫اﻻﺳم ‪:‬‬ ‫ﺗدﻗﯾﻖ ﺧﺎرﺟﻲ‬ ‫ﺗدﻗﯾﻖ داﺧﻠﻲ‬ ‫اﻟﺗﻐذﯾﺔ اﻟراﺟﻌﺔ‬ ‫اﻟدرﺟﺔ‬

‫اﻟﺻف‪:‬‬
‫اﻟرﻗم اﻻﻛﺎدﯾﻣﻲ‪:‬‬

‫اﺳم اﻟﻣﻌﻠﻣﺔ ‪:‬‬

‫(‬ ‫ﻣﮭﻣﺔ اﻟطﺎﻟﺑﺔ ﻟﻣﻘرر ) اﺟﺎ‬
‫اﻟﻣوﺿوع ‪........................................................................................ :‬‬

‫اﻟﻣﻘدﻣﺔ ‪ 4 ) :‬درﺟﺎت (‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬

‫اﻟﻌرض‪ 4 ) :‬درﺟﺎت (‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫اﻟﺧﺎﺗﻣﺔ‪ 2) :‬درﺟﺔ(‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬
‫‪.................................................................................................................................‬‬

‫اﻟﻣﺻﺎدر‪2) :‬درﺟﺔ (‬
‫‪...............................................................................................................................‬‬