‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code: PO-PAE-01‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision: 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date: 01/08/2023‬‬

‫ﺩﻟﻴﻞ ﺇﺟﺮﺍءﺍﺕ ‪ -‬ﻣﺼﻠﺤﺔ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬

‫ﺁﺟﺎﻝ ﺍﻟﺤﺼﻮﻝ‬
‫ﺍﻟﻤﺼﺎﻟﺢ ﺍﻟﻤﻌﻨﻴﺔ‬ ‫ﻣﺮﺍﺣﻞ ﺍﻟﺨﺪﻣﺔ‬ ‫ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬
‫ﻋﻠﻰ ﺍﻟﺨﺪﻣﺔ‬
‫‪ 48‬ﺳﺎﻋﺔ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺷﻬﺎﺩﺓ ﺣﻀﻮﺭ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻣﻊ ﺿﺮﻭﺭﺓ ﺇﻣﻀﺎﺋﻬﺎ ﻣﻦ ﻗﺒﻞ‬ ‫‪FR-PAE-02‬‬
‫ﻣﺪﺭﺳﻴﻦ ﺍﺛﻨﻴﻦ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬ ‫‪1‬‬
‫‪ -‬ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻄﻠﺒﺔ ﺍﻟﺬﻳﻦ ﻫﻢ ﻓﻲ ﻓﺘﺮﺓ ﺗﺮﺑﺺ ﻟﺨﺘﻢ ﺍﻟﺪﺭﺍﺳﺔ‪ ،‬ﺇﻣﻀﺎءﺍﺕ‬
‫ﺍﻟﻤﺪﺭﺳﻴﻦ ﻏﻴﺮ ﻣﻄﻠﻮﺑﺔ ﻭﻋﻠﻴﻬﻢ ﺗﻘﺪﻳﻢ ﻣﺎ ﻳﺜﺒﺖ ﺃﻧﻬﻢ ﺑﺼﺪﺩ ﺍﻟﻘﻴﺎﻡ‬
‫ﺑﺎﻟﺘﺮﺑﺺ ﺍﻟﻤﺬﻛﻮﺭ‪.‬‬
‫‪ 48‬ﺳﺎﻋﺔ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺷﻬﺎﺩﺓ ﻣﻐﺎﺩﺭﺓ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-03‬‬ ‫‪+‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬ ‫ﺍﻟﻤﻠﻒ ﺍﻟﻄﺒﻲ‬
‫‪ -‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ ﺍﻷﺻﻠﻴﺔ ﻟﻠﺴﻨﺔ ﺍﻟﺠﺎﻣﻌﻴﺔ ﺍﻟﺤﺎﻟﻴﺔ‬ ‫‪2‬‬
‫ﻣﻼﺣﻈﺔ ﻫﺎﻣﺔ‪:‬‬ ‫ﺍﻟﻤﺪﺭﺳﻲ‬
‫ﻳﺴﻠﻢ ﺍﻟﺪﻓﺘﺮ ﺍﻟﺼﺤﻲ ﺑﻌﺪ ﺇﻣﻀﺎء ﺗﺼﺮﻳﺢ ﺍﺳﺘﻼﻡ‬ ‫‪ -‬ﺷﻬﺎﺩﺓ ﺗﺜﺒﺖ ﺍﻟﻨﻘﻠﺔ ﺇﻟﻰ ﻣﺆﺳﺴﺔ ﺃﺧﺮﻯ ﺃﻭ ﺍﻟﻨﺠﺎﺡ ﻓﻲ ﻣﻨﺎﻅﺮﺓ ﺇﻋﺎﺩﺓ‬
‫‪FR-PAE-14‬‬ ‫ﺍﻟﺘﻮﺟﻴﻪ‪.‬‬
‫ﻋﺸﺮﺓ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻧﻈﻴﺮ ﻣﻦ ﻭﺛﻴﻘﺔ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-04‬‬ ‫ﺇﺩﺍﺭﻳﺔ‬ ‫‪3‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬
‫‪ -‬ﺷﻬﺎﺩﺓ ﺿﻴﺎﻉ‪.‬‬
‫ﻋﺸﺮﺓ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺇﺻﻼﺡ ﻭﺛﻴﻘﺔ ﺇﺩﺍﺭﻳﺔ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-05‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬
‫‪ -‬ﺍﻷﺻﻞ ﻣﻦ ﺍﻟﻮﺛﻴﻘﺔ ﺍﻟﻤﺮﺍﺩ ﺇﺻﻼﺡ ﻣﺤﺘﻮﺍﻫﺎ‬ ‫‪4‬‬
‫‪ -‬ﻣﻀﻤﻮﻥ ﻭﻻﺩﺓ ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺮﻧﺴﻴﺔ ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬
‫ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ ﻓﻲ ﺣﺎﻟﺔ ﺇﺻﻼﺡ ﻭﺛﻴﻘﺔ ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺮﻧﺴﻴﺔ‪.‬‬

‫‪1‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code: PO-PAE-01‬‬
‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision: 00‬‬
‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date: 01/08/2023‬‬

‫ﺁﺟﺎﻝ ﺍﻟﺤﺼﻮﻝ‬
‫ﺍﻟﻤﺼﺎﻟﺢ ﺍﻟﻤﻌﻨﻴﺔ‬ ‫ﻣﺮﺍﺣﻞ ﺍﻟﺨﺪﻣﺔ‬ ‫ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬
‫ﻋﻠﻰ ﺍﻟﺨﺪﻣﺔ‬
‫‪ -‬ﻣﻄﻠﺐ ﺗﺄﺟﻴﻞ ﻷﺳﺒﺎﺏ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ‪ -‬ﻣﻜﺘﺐ ﺍﻟﻀﺒﻂ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺗﺄﺟﻴﻞ ﺍﻟﺘﺮﺳﻴﻢ‬
‫ﺷﺨﺼﻴﺔ‪ :‬ﺃﺳﺒﻮﻉ ﻣﻦ‬ ‫‪ -‬ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-06‬‬
‫ﺗﺎﺭﻳﺦ ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺇﻳﺪﺍﻉ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﻟﺪﻯ ﻣﻜﺘﺐ ﺍﻟﻀﺒﻂ‬ ‫ﺍﻟﻮﻁﻨﻴﺔ‬ ‫ﺍﻟﺘﻌﺮﻳﻒ‬ ‫ﺑﻄﺎﻗﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ‬
‫‪ -‬ﻣﻄﻠﺐ ﺗﺄﺟﻴﻞ ﻷﺳﺒﺎﺏ‬ ‫ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ‪:‬‬ ‫ﺍﻷﺻﻠﻴﺔ‬ ‫ﺍﻟﺘﺮﺳﻴﻢ‬ ‫‪ -‬ﺷﻬﺎﺩﺓ‬
‫ﺻﺤﻴﺔ‪ :‬ﺇﺛﺮ ﺍﺗﺼﺎﻝ‬ ‫‪ -‬ﺷﻬﺎﺩﺓ ﻁﺒﻴﺔ ﻓﻲ ﻅﺮﻑ ﻣﻐﻠﻖ )ﺧﺎﺻﺔ ﺑﻤﻄﺎﻟﺐ ﺗﺄﺟﻴﻞ ﺍﻟﺘﺮﺳﻴﻢ ﻷﺳﺒﺎﺏ ‪ -‬ﻓﻲ ﺣﺎﻟﺔ ﻁﻠﺐ ﺍﻟﺘﺄﺟﻴﻞ ﻷﺳﺒﺎﺏ ﺷﺨﺼﻴﺔ‪ ،‬ﻳﺠﺐ‬
‫ﺍﻹﺩﺍﺭﺓ ﺑﺎﻟﻤﻌﻨﻲ ﺑﺎﻷﻣﺮ‬ ‫ﺇﻳﺪﺍﻉ ﺍﻟﻤﻠﻒ ﻓﻲ ﺃﺟﻞ ﺃﻗﺼﺎﻩ ‪ 30‬ﻳﻮﻡ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫ﺻﺤﻴﺔ(‬
‫ﺍﻧﻄﻼﻕ ﺍﻟﺪﺭﻭﺱ‪.‬‬ ‫‪5‬‬
‫‪ -‬ﻓﻲ ﺣﺎﻟﺔ ﻁﻠﺐ ﺍﻟﺘﺄﺟﻴﻞ ﻷﺳﺒﺎﺏ ﺻﺤﻴﺔ‪ ،‬ﻳﺠﺐ‬
‫ﺇﻳﺪﺍﻉ ﺍﻟﻤﻠﻒ ﻗﺒﻞ ﺗﺎﺭﻳﺦ ﺇﺟﺮﺍء ﺍﻣﺘﺤﺎﻧﺎﺕ ﺁﺧﺮ ﺍﻟﺴﻨﺔ‬
‫ﺍﻟﺠﺎﻣﻌﻴﺔ ﺍﻟﺤﺎﻟﻴﺔ‪.‬‬
‫‪ -‬ﻳﺴﺘﻈﻬﺮ ﺍﻟﻤﻌﻨﻲ ﺑﺎﻷﻣﺮ ﻓﻲ ﻣﻔﺘﺘﺢ ﺍﻟﺴﻨﺔ ﺍﻟﺠﺎﻣﻌﻴﺔ‬
‫ﺍﻟﻤﻮﺍﻟﻴﺔ ﺑﺸﻬﺎﺩﺓ ﺗﺜﺒﺖ ﺷﻔﺎءﻩ ﻣﻦ ﺍﻟﻤﺮﺽ ﺇﻥ ﻛﺎﻥ‬
‫ﺍﻟﺘﺄﺟﻴﻞ ﻷﺳﺒﺎﺏ ﺻﺤﻴﺔ‪.‬‬
‫ﺗﺤﺪﺩ ﻓﻲ ﺍﻹﺑﺎﻥ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ‪ -‬ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺗﺜﻤﻴﻦ ﺍﻟﻮﺣﺪﺍﺕ‬
‫‪ -‬ﺇﺩﺍﺭﺓ ﺍﻟﺪﺭﺍﺳﺎﺕ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-07‬‬
‫‪ -‬ﺭﺅﺳﺎء ﺍﻷﻗﺴﺎﻡ‬ ‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫ﻣﻦ‬ ‫ﻧﺴﺨﺔ‬ ‫ﺃﻭ‬ ‫(‬ ‫ﺍﻟﺘﺮﺳﻴﻢ‬ ‫ﺷﻬﺎﺩﺓ‬ ‫‪+‬‬ ‫ﺍﻟﻮﻁﻨﻴﺔ‬ ‫ﺍﻟﺘﻌﺮﻳﻒ‬ ‫ﺑﻄﺎﻗﺔ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ‬
‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬ ‫‪6‬‬
‫ﻣﻼﺣﻈﺔ ﻫﺎﻣﺔ‪:‬‬
‫ﻻ ﻳﻨﺘﻔﻊ ﻁﻠﺒﺔ ﺍﻟﻤﺮﺣﻠﺔ ﺍﻟﺘﺤﻀﻴﺮﻳﺔ ﺍﻟﺬﻳﻦ ﺍﻧﺘﻘﻠﻮﺍ ﺇﻟﻰ‬ ‫ﺍﻟﻄﺎﻟﺐ‬ ‫ﺩﺭﺳﻬﺎ‬ ‫ﺟﺎﻣﻌﻴﺔ‬ ‫ﺳﻨﺔ‬ ‫ﻵﺧﺮ‬ ‫ﺍﻷﻋﺪﺍﺩ‬ ‫ﺑﻄﺎﻗﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ‬
‫ﻧﻈﺎﻡ ﺇ‪.‬ﻡ‪.‬ﺩ ﺑﺘﺜﻤﻴﻦ ﺍﻟﻮﺣﺪﺍﺕ‪.‬‬
‫ﺗﺤﺪﺩ ﻓﻲ ﺍﻹﺑﺎﻥ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ‪ -‬ﻣﻜﺘﺐ ﺍﻟﻀﺒﻂ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺍﻻﻁﻼﻉ ﻋﻠﻰ ﻭﺭﻗﺔ‬
‫‪ -‬ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-08‬‬ ‫ﺍﻻﻣﺘﺤﺎﻥ‬
‫‪ -‬ﺇﻳﺪﺍﻉ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﻟﺪﻯ ﻣﻜﺘﺐ ﺍﻟﻀﺒﻂ‬ ‫ﻣﻦ‬ ‫ﻧﺴﺨﺔ‬ ‫ﺃﻭ‬ ‫(‬ ‫ﺍﻟﺘﺮﺳﻴﻢ‬ ‫ﺷﻬﺎﺩﺓ‬ ‫‪+‬‬ ‫ﺍﻟﻮﻁﻨﻴﺔ‬ ‫ﺍﻟﺘﻌﺮﻳﻒ‬ ‫ﺑﻄﺎﻗﺔ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ‬
‫ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ‪:‬‬ ‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬
‫‪7‬‬
‫‪ -‬ﻳﺴﻤﺢ ﻟﻠﻄﺎﻟﺐ ﺑﺎﻻﻁﻼﻉ ﻋﻠﻰ ﻭﺭﻗﺘﻲ )‪ (2‬ﺍﻣﺘﺤﺎﻥ‬
‫ﻋﻠﻰ ﺍﻷﻛﺜﺮ‪.‬‬
‫‪ -‬ﻳﺴﻤﺢ ﻟﻠﻄﺎﻟﺐ ﺑﺎﻻﻁﻼﻉ ﻋﻠﻰ ﻭﺭﻗﺔ ﺍﻻﻣﺘﺤﺎﻥ‬
‫ﻟﻠﺘﺜﺒﺖ ﻓﻲ ﺻﺤﺔ ﺍﻟﻌﺪﺩ ﺍﻟﻤﺴﻨﺪ ﻟﻪ ﻭ ﻛﻞ ﺧﻄﺄ ﻣﺎﺩﻱ‬

‫‪2‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code: PO-PAE-01‬‬
‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision: 00‬‬
‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date: 01/08/2023‬‬

‫ﺁﺟﺎﻝ ﺍﻟﺤﺼﻮﻝ‬
‫ﺍﻟﻤﺼﺎﻟﺢ ﺍﻟﻤﻌﻨﻴﺔ‬ ‫ﻣﺮﺍﺣﻞ ﺍﻟﺨﺪﻣﺔ‬ ‫ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬
‫ﻋﻠﻰ ﺍﻟﺨﺪﻣﺔ‬
‫ﻳﺴﺘﻮﺟﺐ ﺇﺻﻼﺣﻪ ﻋﻠﻰ ﺃﻥ ﻫﺬﻩ ﺍﻹﻣﻜﺎﻧﻴﺔ ﻻ ﺗﻌﻨﻲ‬
‫ﺇﻋﺎﺩﺓ ﺇﺻﻼﺡ ﻭﺭﻗﺔ ﺍﻻﻣﺘﺤﺎﻥ‪.‬‬
‫‪ -‬ﻻ ﻳﻤﻜﻦ ﻟﻠﻄﺎﻟﺐ ﺍﻟﻤﻄﺎﻟﺒﺔ ﺑﺎﻻﻁﻼﻉ ﻋﻠﻰ ﺍﻷﻭﺭﺍﻕ‬
‫ﺍﻟﺨﺎﺻﺔ ﺑﻔﺮﻭﺽ ﺍﻟﻤﺮﺍﻗﺒﺔ ﺃﻭ ﺑﺎﻷﺷﻐﺎﻝ ﺍﻟﺘﻄﺒﻴﻘﻴﺔ‪.‬‬
‫‪ -‬ﻻ ﺗﻨﻈﺮ ﺍﻹﺩﺍﺭﺓ ﻓﻲ ﺍﻟﻤﻄﺎﻟﺐ ﺍﻟﻮﺍﺭﺩﺓ ﺑﻌﺪ ﺃﺳﺒﻮﻉ‬
‫ﻋﻤﻞ ﺍﺑﺘﺪﺍء ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻹﻋﻼﻥ ﻋﻦ ﺍﻟﻨﺘﺎﺋﺞ‪.‬‬
‫ﺗﺤﺪﺩ ﻓﻲ ﺍﻹﺑﺎﻥ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺗﺴﺠﻴﻞ ﺍﺳﺘﺜﻨﺎﺋﻲ‬
‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-09‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬
‫ﻣﻼﺣﻈﺔ ﻫﺎﻣﺔ‪:‬‬
‫‪ -‬ﻋﻠﻰ ﺍﻟﻄﻠﺒﺔ ﺍﻟﺮﺍﻏﺒﻴﻦ ﺑﺎﻟﺘﺴﺠﻴﻞ ﺍﻻﺳﺘﺜﻨﺎﺋﻲ ﻛﻄﻠﺒﺔ‬ ‫‪8‬‬
‫ﻧﻈﺎﻣﻴﻴﻦ ﺗﻌﻤﻴﺮ ﻣﻄﺒﻮﻋﺔ ﺍﻟﺘﺰﺍﻡ ﺗﺤﻤﻞ ﺍﻹﻣﻀﺎء‬
‫ﻣﻌﺮﻓﺎ ﺑﻪ )‪ (FR-PAE-13‬ﻭ ﺇﻳﺪﺍﻋﻬﺎ ﻣﻊ ﻣﻠﻒ‬
‫ﺍﻟﺘﺮﺳﻴﻢ‪.‬‬

‫‪ 48‬ﺳﺎﻋﺔ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺷﻬﺎﺩﺓ ﻧﺠﺎﺡ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-10‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬ ‫‪9‬‬
‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬

‫‪ 48‬ﺳﺎﻋﺔ ﻣﻦ ﺗﺎﺭﻳﺦ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬
‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﺍﺳﺘﺨﺮﺍﺝ‬
‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-11‬‬ ‫ﻛﺸﻒ ﺃﻋﺪﺍﺩ ﺑﺎﻷﺭﺻﺪﺓ‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬
‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬ ‫‪10‬‬
‫‪ -‬ﺑﻄﺎﻗﺔ ﺃﻋﺪﺍﺩ ﺃﺻﻠﻴﺔ‬

‫‪3‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code: PO-PAE-01‬‬
‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision: 00‬‬
‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date: 01/08/2023‬‬

‫ﺁﺟﺎﻝ ﺍﻟﺤﺼﻮﻝ‬
‫ﺍﻟﻤﺼﺎﻟﺢ ﺍﻟﻤﻌﻨﻴﺔ‬ ‫ﻣﺮﺍﺣﻞ ﺍﻟﺨﺪﻣﺔ‬ ‫ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬
‫ﻋﻠﻰ ﺍﻟﺨﺪﻣﺔ‬
‫‪ 48‬ﺳﺎﻋﺔ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﺍﺳﺘﺨﺮﺍﺝ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-12‬‬ ‫ﻛﺸﻒ ﺃﻋﺪﺍﺩ ﺑﺎﻟﺮﺗﺒﺔ‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬ ‫‪11‬‬
‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬
‫‪ -‬ﺑﻄﺎﻗﺔ ﺃﻋﺪﺍﺩ ﺃﺻﻠﻴﺔ‬
‫‪---‬‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺍﻟﺘﺰﺍﻡ ﺧﺎﺹ‬
‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-13‬‬ ‫ﺑﺎﻟﺤﺎﺻﻠﻴﻦ ﻋﻠﻰ‬
‫ﺧﻼﻝ ﻋﻤﻠﻴﺔ ﺍﻟﺘﺮﺳﻴﻢ ﺑﻌﺪ ﺍﻟﺤﺼﻮﻝ ﻋﻠﻰ ﻣﻮﺍﻓﻘﺔ‬ ‫ﺗﺴﺠﻴﻞ ﺍﺳﺘﺜﻨﺎﺋﻲ‬
‫ﺍﻹﺩﺍﺭﺓ ﻋﻠﻰ ﺍﻟﺘﺴﺠﻴﻞ ﺍﻻﺳﺘﺜﻨﺎﺋﻲ‪.‬‬
‫ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ‪:‬‬
‫‪ -‬ﻫﺬﺍ ﺍﻻﻟﺘﺰﺍﻡ ﻏﻴﺮ ﺇﺟﺒﺎﺭﻱ‪ .‬ﺇﺫﺍ ﻟﻢ ﻳﻘﻊ ﺗﻘﺪﻳﻤﻪ‬
‫ﺧﻼﻝ ﻋﻤﻠﻴﺔ ﺍﻟﺘﺮﺳﻴﻢ ﻓﺈﻥ ﺍﻟﻄﺎﻟﺐ ﻳﻌﺘﺒﺮ ﻏﻴﺮ ﻧﻈﺎﻣﻲ‬
‫ﻭ ﺑﺬﻟﻚ ﻳﺘﻮﺟﺐ ﻋﻠﻴﻪ ﺍﻟﺤﻀﻮﺭ ﻓﻲ‪ :‬ﺍﻣﺘﺤﺎﻧﺎﺕ ﺁﺧﺮ‬
‫ﺍﻟﺴﺪﺍﺳﻲ‪ ،‬ﻓﺮﺽ ﺍﻟﻤﺮﺍﻗﺒﺔ ﻋﺪﺩ ‪ 2‬ﻭ ﺣﺼﺺ‬
‫ﺍﻹﺷﻐﺎﻝ ﺍﻟﺘﻄﺒﻴﻘﻴﺔ ﻭ ﺍﻣﺘﺤﺎﻧﺎﺗﻬﺎ ﺩﻭﻥ ﺳﻮﺍﻫﻢ‪.‬‬ ‫‪12‬‬
‫‪ -‬ﻳﻌﺘﺒﺮ ﺍﻟﻄﺎﻟﺐ ﺍﻟﻤﻤﻀﻲ ﻋﻠﻰ ﻫﺬﺍ ﺍﻻﻟﺘﺰﺍﻡ ﻁﺎﻟﺒﺎ‬
‫ﻧﻈﺎﻣﻴﺎ ﻭﺑﺎﻟﺘﺎﻟﻲ ﺗﻄﺒﻖ ﻋﻠﻴﻪ ﺟﻤﻴﻊ ﺍﻹﺟﺮﺍءﺍﺕ‬
‫ﺍﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻻﻣﺘﺤﺎﻧﺎﺕ ﻭ ﺑﻌﺪﺩ ﺍﻟﻐﻴﺎﺑﺎﺕ ﺍﻟﻤﺴﻤﻮﺡ ﺑﻪ‪.‬‬
‫‪ -‬ﻳﻠﺘﺰﻡ ﺍﻟﻄﺎﻟﺐ ﺍﻟﻤﻤﻀﻲ ﻋﻠﻰ ﺍﻻﻟﺘﺰﺍﻡ ﺍﻟﻤﺬﻛﻮﺭ‬
‫ﺑﺎﻟﺤﻀﻮﺭ ﻓﻲ ﺟﻤﻴﻊ ﺣﺼﺺ ﺍﻟﺘﺪﺭﻳﺲ ﺍﻟﻤﺒﺮﻣﺠﺔ‬
‫ﻣﻦ ﺩﺭﻭﺱ ﻭ ﺃﺷﻐﺎﻝ ﻣﺴﻴﺮﺓ ﻭ ﺣﺼﺺ ﺍﻷﺷﻐﺎﻝ‬
‫ﺍﻟﺘﻄﺒﻴﻘﻴﺔ‪ ،‬ﻛﻤﺎ ﻳﻠﺘﺰﻡ ﺑﺈﺟﺮﺍء ﺍﻣﺘﺤﺎﻧﺎﺕ ﻓﺮﻭﺽ‬
‫ﺍﻟﻤﺮﺍﻗﺒﺔ ﻟﻤﺨﺘﻠﻒ ﺍﻟﻤﻮﺍﺩ ﻭ ﺍﻣﺘﺤﺎﻧﺎﺕ ﻧﻬﺎﻳﺔ‬
‫ﺍﻟﺴﺪﺍﺳﻴﻴﻦ ﺍﻷﻭﻝ ﻭ ﺍﻟﺜﺎﻧﻲ ﻟﻠﺴﻨﺔ ﺍﻟﺠﺎﻣﻌﻴﺔ ﺍﻟﻤﻌﻨﻴﺔ‪.‬‬

‫‪4‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code: PO-PAE-01‬‬
‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision: 00‬‬
‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date: 01/08/2023‬‬

‫ﺁﺟﺎﻝ ﺍﻟﺤﺼﻮﻝ‬
‫ﺍﻟﻤﺼﺎﻟﺢ ﺍﻟﻤﻌﻨﻴﺔ‬ ‫ﻣﺮﺍﺣﻞ ﺍﻟﺨﺪﻣﺔ‬ ‫ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬
‫ﻋﻠﻰ ﺍﻟﺨﺪﻣﺔ‬
‫‪---‬‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺗﺼﺮﻳﺢ )ﻻﺳﺘﻼﻡ‬
‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﻳﺪﺍﻋﻬﺎ ﺑﻤﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪FR-PAE-14‬‬ ‫ﺍﻟﺪﻓﺘﺮ ﺍﻟﺼﺤﻲ(‬
‫ﻋﻨﺪ ﺍﺳﺘﻼﻡ ﺍﻟﺪﻓﺘﺮ ﺍﻟﺼﺤﻲ‪.‬‬
‫ﻣﻼﺣﻈﺔ ﻫﺎﻣﺔ‪:‬‬ ‫‪13‬‬
‫ﻻ ﻳﺴﻠﻢ ﺍﻟﺪﻓﺘﺮ ﺍﻟﺼﺤﻲ ﺇﻻ ﻟﻠﻄﻠﺒﺔ ﻟﻠﻤﺘﺤﺼﻠﻴﻦ ﻋﻠﻰ‬
‫ﺷﻬﺎﺩﺓ ﻣﻐﺎﺩﺭﺓ‪.‬‬

‫ﺗﺤﺪﺩ ﻓﻲ ﺍﻹﺑﺎﻥ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﻧﻘﻠﺔ ﺑﻴﻦ‬
‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-15‬‬ ‫ﺍﻷﻓﻮﺍﺝ‬ ‫‪14‬‬
‫‪ -‬ﺇﻳﺪﺍﻉ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﻟﺪﻯ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬
‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬
‫ﺗﺤﺪﺩ ﻓﻲ ﺍﻹﺑﺎﻥ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﻣﻨﺎﻗﻠﺔ ﺑﻴﻦ‬
‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-16‬‬ ‫ﺍﻷﻓﻮﺍﺝ‬ ‫‪15‬‬
‫‪ -‬ﺇﻳﺪﺍﻉ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﻟﺪﻯ ﻣﻜﺘﺐ ﺍﻟﻀﺒﻂ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ﻟﻜﻞ ﻁﺎﻟﺐ‬
‫‪ 48‬ﺳﺎﻋﺔ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﺍﺳﺘﺨﺮﺍﺝ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-17‬‬ ‫ﻛﺸﻒ ﺃﻋﺪﺍﺩ‬
‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬ ‫‪16‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫ﺍﻟﺴﻨﺔ ﺍﻟﺜﺎﻟﺜﺔ ﻣﺴﺘﻤﺮ‬
‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬
‫ﺗﺤﺪﺩ ﻓﻲ ﺍﻹﺑﺎﻥ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ‪ -‬ﻣﻜﺘﺐ ﺍﻟﻀﺒﻂ‬ ‫ﻣﻄﻠﺐ ﺗﺤﺼﻴﻞ ﺃﺭﺻﺪﺓ ‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬
‫‪ -‬ﺷﺆﻭﻥ ﺍﻟﺪﺭﺍﺳﺔ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-18‬‬
‫‪ -‬ﺇﻳﺪﺍﻉ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﻟﺪﻯ ﻣﻜﺘﺐ ﺍﻟﻀﺒﻂ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬
‫ﻣﻼﺣﻈﺔ ﻫﺎﻣﺔ‪:‬‬ ‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻷﻋﺪﺍﺩ ﻟﻠﻤﻮﺍﺩ ﺍﻟﻤﺘﻌﻠﻘﺔ ﺑﺴﻨﺔ ﺩﺭﺍﺳﻴﺔ ﻣﻨﻘﻀﻴﺔ‬ ‫‪17‬‬
‫‪ -‬ﺗﻮﺩﻉ ﺍﻟﻤﻄﺎﻟﺐ ﻭﺟﻮﺑﺎ ﺑﻤﻜﺘﺐ ﺍﻟﻀﺒﻂ ﺑﻌﺪ‬
‫ﺍﻟﺘﺼﺮﻳﺢ ﺑﻨﺘﺎﺋﺞ ﺍﻟﺪﻭﺭﺓ ﺍﻟﺮﺋﻴﺴﻴﺔ ﻭ ﻗﺒﻞ ﺛﻼﺛﺔ ﺃﻳﺎﻡ‬
‫)‪ (3‬ﻋﻤﻞ ﻣﻦ ﺍﻧﻄﻼﻕ ﺍﻣﺘﺤﺎﻧﺎﺕ ﺩﻭﺭﺓ ﺍﻟﺘﺪﺍﺭﻙ‪.‬‬

‫‪5‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code: PO-PAE-01‬‬
‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision: 00‬‬
‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date: 01/08/2023‬‬

‫ﺁﺟﺎﻝ ﺍﻟﺤﺼﻮﻝ‬
‫ﺍﻟﻤﺼﺎﻟﺢ ﺍﻟﻤﻌﻨﻴﺔ‬ ‫ﻣﺮﺍﺣﻞ ﺍﻟﺨﺪﻣﺔ‬ ‫ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬
‫ﻋﻠﻰ ﺍﻟﺨﺪﻣﺔ‬
‫‪ 48‬ﺳﺎﻋﺔ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﻟﻠﺤﺼﻮﻝ ﻋﻠﻰ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-19‬‬ ‫ﺑﻄﺎﻗﺔ ﻭﺿﻌﻴﺔ ﺟﺎﻣﻌﻴﺔ‬ ‫‪18‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺃﻋﺪﺍﺩ ﺍﻟﺒﺎﻛﺎﻟﻮﺭﻳﺎ‬
‫ﺳﺘﺔ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ ﺗﻘﺪﻳﻢ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﻟﻠﺤﺼﻮﻝ ﻋﻠﻰ‬
‫ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-20‬‬ ‫ﺷﻬﺎﺩﺓ ﺇﻓﺎﺩﺓ‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﻤﺘﺤﺼﻞ ﻋﻠﻴﻬﺎ ﻣﻦ ﺍﻟﻤﻌﻬﺪ‬ ‫‪19‬‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺃﻭ ﺑﻄﺎﻗﺎﺕ ﺍﻷﻋﺪﺍﺩ ﻟﺴﻨﺔ ﺃﻭ ﺳﻨﻮﺍﺕ ﺍﻟﺪﺭﺍﺳﺔ‬
‫ﺍﻟﺠﺎﻣﻌﻴﺔ ﺍﻟﻤﻘﻀّﺎﺓ ﺑﻤﺆﺳﺴﺔ ﺃﺧﺮﻯ‬
‫‪ 48‬ﺳﺎﻋﺔ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﻣﻜﺘﺐ ﺍﻟﻀﺒﻂ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﻣﺴﺎﻋﺪﺓ ﺧﺎﺹ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-21‬‬ ‫ﺑﺎﻟﻄﻠﺒﺔ ﺫﻭﻱ‬ ‫‪20‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺍﻟﻀﺒﻂ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬ ‫ﺍﻻﺣﺘﻴﺎﺟﺎﺕ ﺍﻟﺨﺎﺻﺔ‬
‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ‬
‫ﻋﺸﺮﺓ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﺑﻌﺚ ﻧﺎﺩﻱ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-22‬‬ ‫ﻁﻼﺑﻲ‬
‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬ ‫‪21‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﻣﻦ ﻗﺒﻞ ﺍﻟﻄﺎﻟﺐ ﺭﺋﻴﺲ ﺍﻟﻨﺎﺩﻱ‬
‫ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ ﻟﻠﻄﺎﻟﺐ ﺭﺋﻴﺲ ﺍﻟﻨﺎﺩﻱ‬
‫ﺳﺘﺔ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ ﺗﻘﺪﻳﻢ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﺗﺠﺪﻳﺪ ﻧﺎﺩﻱ‬
‫ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-23‬‬ ‫ﻁﻼﺑﻲ‬
‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬ ‫‪22‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﻣﻦ ﻗﺒﻞ ﺍﻟﻄﺎﻟﺐ ﺭﺋﻴﺲ ﺍﻟﻨﺎﺩﻱ‬
‫ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ ﻟﻠﻄﺎﻟﺐ ﺭﺋﻴﺲ ﺍﻟﻨﺎﺩﻱ‬
‫ﺳﺒﻌﺔ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ ‪FR-PAE-24‬‬ ‫ﻣﻄﻠﺐ ﻟﻠﻘﻴﺎﻡ ﺑﻨﺸﺎﻁ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪) -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺘﺮﺳﻴﻢ( ﺃﻭ ﻧﺴﺨﺔ ﻣﻦ‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﻣﻦ ﻗﺒﻞ ﺍﻟﻄﺎﻟﺐ ﺭﺋﻴﺲ ﺍﻟﻨﺎﺩﻱ‬ ‫ﺑﻄﺎﻗﺔ ﻁﺎﻟﺐ ﻟﻠﻄﺎﻟﺐ ﺭﺋﻴﺲ ﺍﻟﻨﺎﺩﻱ‬ ‫‪23‬‬
‫ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﺑﺮﻧﺎﻣﺞ ﺍﻟﻨﺸﺎﻁ‬
‫‪ -‬ﻗﺎﺋﻤﺔ ﺍﻟﻄﻠﺒﺔ ﺍﻟﻤﻨﻈﻤﻴﻦ ﻟﻠﻨﺸﺎﻁ‬

‫‪6‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code: PO-PAE-01‬‬
‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision: 00‬‬
‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date: 01/08/2023‬‬

‫ﺁﺟﺎﻝ ﺍﻟﺤﺼﻮﻝ‬
‫ﺍﻟﻤﺼﺎﻟﺢ ﺍﻟﻤﻌﻨﻴﺔ‬ ‫ﻣﺮﺍﺣﻞ ﺍﻟﺨﺪﻣﺔ‬ ‫ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬
‫ﻋﻠﻰ ﺍﻟﺨﺪﻣﺔ‬
‫ﺳﺘﺔ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ ﺗﻘﺪﻳﻢ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻣﻄﻠﺐ ﺷﻬﺎﺩﺓ ﺇﺛﺒﺎﺕ‬
‫ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-25‬‬ ‫ﺍﻟﺪﺭﺍﺳﺔ ﺑﺎﻟﻠﻐﺔ‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬ ‫ﺍﻟﻔﺮﻧﺴﻴﺔ )ﺧﺎﺹ‬ ‫‪24‬‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﺠﺎﻣﻌﻴﺔ‬ ‫ﺑﺎﻟﻄﻠﺒﺔ ﺍﻟﻤﺘﺨﺮﺟﻴﻦ(‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺁﺧﺮ ﺑﻄﺎﻗﺔ ﺃﻋﺪﺍﺩ‬
‫ﺛﻼﺛﺔ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ )‪ (FR-PAE-25‬ﺇﻟﻰ ﺍﻟﺴﻴﺪ ﺍﻟﻜﺎﺗﺐ ﺍﻟﻌﺎﻡ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ ﻣﻦ ﻗﺒﻞ ﺍﻟﻜﺎﺗﺐ ﺍﻟﻌﺎﻡ‬ ‫ﺷﻬﺎﺩﺓ ﺇﺛﺒﺎﺕ ﺍﻟﺪﺭﺍﺳﺔ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫ﺍﻟﻜﺘﺎﺑﺔ ﺍﻟﻌﺎﻣﺔ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ )‪ (FR-PAE-26‬ﻣﻦ ﻁﺮﻑ‬ ‫‪FR-PAE-26‬‬ ‫ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺮﻧﺴﻴﺔ‬
‫‪25‬‬
‫ﺍﻟﻜﺎﺗﺐ ﺍﻟﻌﺎﻡ‬ ‫)ﺧﺎﺹ ﺑﺎﻟﻄﻠﺒﺔ‬
‫‪ -‬ﺗﺴﻠﻴﻢ ﺍﻟﺸﻬﺎﺩﺓ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫ﺍﻟﻤﺘﺨﺮﺟﻴﻦ(‬
‫ﺳﺘﺔ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ ﺗﻘﺪﻳﻢ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﻁﻠﺐ ﺍﻟﺒﺮﻧﺎﻣﺞ‬
‫ﺍﻟﻤﻄﻠﺐ‬ ‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭ ﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪FR-PAE-27‬‬ ‫ﺍﻟﺪﺭﺍﺳﻲ ﺍﻟﺘﻔﺼﻴﻠﻲ‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻠﻒ ﻛﺎﻣﻼ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬ ‫)ﺧﺎﺹ ﺑﺎﻟﻄﻠﺒﺔ‬ ‫‪26‬‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﺠﺎﻣﻌﻴﺔ‬ ‫ﺍﻟﻤﺘﺨﺮﺟﻴﻦ(‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺁﺧﺮ ﺑﻄﺎﻗﺔ ﺃﻋﺪﺍﺩ‬
‫ﺛﻼﺛﺔ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ‬ ‫ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ )‪ (FR-PAE-19‬ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ‬ ‫ﺑﻄﺎﻗﺔ ﻭﺿﻌﻴﺔ ﺟﺎﻣﻌﻴﺔ ‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬
‫ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ‬ ‫ﺍﻟﻜﺘﺎﺑﺔ ﺍﻟﻌﺎﻣﺔ‬ ‫ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ‬ ‫‪FR-PAE-28‬‬
‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬ ‫‪27‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﺠﺎﻣﻌﻴﺔ‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺁﺧﺮ ﺑﻄﺎﻗﺔ ﺃﻋﺪﺍﺩ‬
‫ﺳﺘﺔ ﺃﻳﺎﻡ ﻣﻦ ﺗﺎﺭﻳﺦ ﺗﻘﺪﻳﻢ‬ ‫ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﺳﺤﺐ ﺍﻟﻤﻄﺒﻮﻋﺔ )‪ (FR-PAE-20‬ﺃﻭ ﺗﻨﺰﻳﻠﻬﺎ ﻣﻦ‬ ‫‪ -‬ﻣﻄﺒﻮﻋﺔ ﺗﻌﻤﺮ ﻓﻲ ﺍﻟﻐﺮﺽ‬ ‫ﺷﻬﺎﺩﺓ ﺇﻓﺎﺩﺓ‬
‫ﺍﻟﻤﻄﻠﺐ‬ ‫ﻣﺪﻳﺮ ﺍﻟﻤﺆﺳﺴﺔ‬ ‫ﻣﻮﻗﻊ ﻭﺍﺏ ﺍﻟﻤﻌﻬﺪ‬ ‫‪FR-PAE-29‬‬
‫‪ -‬ﺗﻌﻤﻴﺮ ﺍﻟﻤﻄﺒﻮﻋﺔ ﻭﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﻄﻠﻮﺑﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻁﻨﻴﺔ‬ ‫‪28‬‬
‫‪ -‬ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﻠﺐ ﺇﻟﻰ ﻣﻜﺘﺐ ﺷﺆﻭﻥ ﺍﻟﻄﻠﺒﺔ‬ ‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﺠﺎﻣﻌﻴﺔ‬
‫‪ -‬ﻧﺴﺨﺔ ﻣﻦ ﺁﺧﺮ ﺑﻄﺎﻗﺔ ﺃﻋﺪﺍﺩ‬

‫‪7‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-01‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻗﺎﺋﻣﺔ ﺍﻟﻣﻁﺑﻭﻋﺎﺕ ﺍﻟﺧﺎﺻﺔ ﺑﻣﺻﻠﺣﺔ ﺷﺅﻭﻥ ﺍﻟﻁﻠﺑﺔ‬

‫ﺍﺳﻡ ﺍﻟﻣﻁﺑﻭﻋﺔ‬ ‫ﺭﻣﺯ ﺍﻟﻣﻁﺑﻭﻋﺔ‬

‫ﻗﺎﺋﻣﺔ ﺍﻟﻣﻁﺑﻭﻋﺎﺕ ﺍﻟﺧﺎﺻﺔ ﺑﻣﺻﻠﺣﺔ ﺷﺅﻭﻥ ﺍﻟﻁﻠﺑﺔ‬ ‫‪FR-PAE-01‬‬

‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﺷﻬﺎﺩﺓ ﺣﺿﻭﺭ‬ ‫‪FR-PAE-02‬‬
‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﺷﻬﺎﺩﺓ ﻣﻐﺎﺩﺭﺓ ‪ +‬ﺍﻟﻣﻠﻑ ﺍﻟﻁﺑﻲ‬ ‫‪FR-PAE-03‬‬
‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﻧﻅﻳﺭ ﻣﻥ ﻭﺛﻳﻘﺔ ﺇﺩﺍﺭﻳﺔ‬ ‫‪FR-PAE-04‬‬
‫ﻣﻁﻠﺏ ﺇﺻﻼﺡ ﻭﺛﻳﻘﺔ ﺇﺩﺍﺭﻳﺔ‬ ‫‪FR-PAE-05‬‬
‫ﻣﻁﻠﺏ ﺗﺄﺟﻳﻝ ﺍﻟﺗﺭﺳﻳﻡ *‬ ‫‪FR-PAE-06‬‬
‫ﻣﻁﻠﺏ ﺗﺛﻣﻳﻥ ﺍﻟﻭﺣﺩﺍﺕ‬ ‫‪FR-PAE-07‬‬
‫ﻣﻁﻠﺏ ﻟﻼﻁﻼﻉ ﻋﻠﻰ ﻭﺭﻗﺔ ﺍﻻﻣﺗﺣﺎﻥ *‬ ‫‪FR-PAE-08‬‬
‫ﻣﻁﻠﺏ ﺗﺳﺟﻳﻝ ﺍﺳﺗﺛﻧﺎﺋﻲ‬ ‫‪FR-PAE-09‬‬
‫ﻣﻁﻠﺏ ﺍﺳﺗﺧﺭﺍﺝ ﺷﻬﺎﺩﺓ ﻧﺟﺎﺡ‬ ‫‪FR-PAE-10‬‬
‫ﻣﻁﻠﺏ ﺍﺳﺗﺧﺭﺍﺝ ﻛﺷﻑ ﺃﻋﺩﺍﺩ ﺑﺎﻷﺭﺻﺩﺓ‬ ‫‪FR-PAE-11‬‬
‫ﻣﻁﻠﺏ ﺍﺳﺗﺧﺭﺍﺝ ﻛﺷﻑ ﺃﻋﺩﺍﺩ ﺑﺎﻟﺭﺗﺑﺔ‬ ‫‪FR-PAE-12‬‬
‫ﺍﻟﺗﺯﺍﻡ ﺧﺎﺽ ﺑﺎﻟﺣﺎﺻﻠﻳﻥ ﻋﻠﻰ ﺗﺳﺟﻳﻝ ﺍﺳﺗﺛﻧﺎﺋﻲ‬ ‫‪FR-PAE-13‬‬
‫ﺗﺻﺭﻳﺢ ﺍﺳﺗﻼﻡ ﺍﻟﺩﻓﺗﺭ ﺍﻟﺻﺣﻲ‬ ‫‪FR-PAE-14‬‬
‫ﻣﻁﻠﺏ ﻧﻘﻠﺔ ﺑﻳﻥ ﺍﻷﻓﻭﺍﺝ *‬ ‫‪FR-PAE-15‬‬
‫ﻣﻁﻠﺏ ﻣﻧﺎﻗﻠﺔ ﺑﻳﻥ ﺍﻷﻓﻭﺍﺝ *‬ ‫‪FR-PAE-16‬‬
‫ﻣﻁﻠﺏ ﺍﺳﺗﺧﺭﺍﺝ ﻛﺷﻑ ﺃﻋﺩﺍﺩ ﺍﻟﺳﻧﺔ ﺍﻟﺛﺎﻟﺛﺔ ﻣﺳﺗﻣﺭ‬ ‫‪FR-PAE-17‬‬
‫ﻣﻁﻠﺏ ﺗﺣﺻﻳﻝ ﺃﺭﺻﺩﺓ *‬ ‫‪FR-PAE-18‬‬
‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﺑﻁﺎﻗﺔ ﻭﺿﻌﻳﺔ ﺟﺎﻣﻌﻳﺔ‬ ‫‪FR-PAE-19‬‬
‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﺷﻬﺎﺩﺓ ﺇﻓﺎﺩﺓ‬ ‫‪FR-PAE-20‬‬
‫ﻣﻁﻠﺏ ﻣﺳﺎﻋﺩﺓ ﺧﺎﺹ ﺑﺎﻟﻁﻠﺑﺔ ﺫﻭﻱ ﺍﻻﺣﺗﻳﺎﺟﺎﺕ ﺍﻟﺧﺎﺻﺔ *‬ ‫‪FR-PAE-21‬‬
‫ﻣﻁﻠﺏ ﺑﻌﺙ ﻧﺎﺩﻱ ﻁﻼﺑﻲ‬ ‫‪FR-PAE-22‬‬
‫ﻣﻁﻠﺏ ﺗﺟﺩﻳﺩ ﻧﺎﺩﻱ ﻁﻼﺑﻲ‬ ‫‪FR-PAE-23‬‬
‫ﻣﻁﻠﺏ ﻟﻠﻘﻳﺎﻡ ﺑﻧﺷﺎﻁ‬ ‫‪FR-PAE-24‬‬
‫ﻣﻁﻠﺏ ﺷﻬﺎﺩﺓ ﺗﺛﺑﺕ ﺍﻟﺩﺭﺍﺳﺔ ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺭﻧﺳﻳﺔ )ﺧﺎﺹ ﺑﺎﻟﻁﻠﺑﺔ ﺍﻟﻣﺗﺧﺭﺟﻳﻥ(‬ ‫‪FR-PAE-25‬‬
‫ﺷﻬﺎﺩﺓ ﺇﺛﺑﺎﺕ ﺍﻟﺩﺭﺍﺳﺔ ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺭﻧﺳﻳﺔ )ﺧﺎﺹ ﺑﺎﻟﻁﻠﺑﺔ ﺍﻟﻣﺗﺧﺭﺟﻳﻥ(‬ ‫‪FR-PAE-26‬‬
‫ﻁﻠﺏ ﺍﻟﺑﺭﻧﺎﻣﺞ ﺍﻟﺩﺭﺍﺳﻲ ﺍﻟﺗﻔﺻﻳﻠﻲ )ﺧﺎﺹ ﺑﺎﻟﻁﻠﺑﺔ ﺍﻟﻣﺗﺧﺭﺟﻳﻥ(‬ ‫‪FR-PAE-27‬‬
‫ﺷﻬﺎﺩﺓ ﻭﺿﻌﻳﺔ ﺟﺎﻣﻌﻳﺔ‬ ‫‪FR-PAE-28‬‬
‫ﺷﻬﺎﺩﺓ ﺇﻓﺎﺩﺓ‬ ‫‪FR-PAE-29‬‬

‫ﺗﻭﺩﻉ ﺍﻟﻣﻁﺎﻟﺏ ﺑﻌﺩ ﺗﻌﻣﻳﺭﻫﺎ ﻭﺇﺭﻓﺎﻗﻬﺎ ﺑﺎﻟﻭﺛﺎﺋﻖ ﺍﻟﻼﺯﻣﺔ ﺑﻣﻛﺗﺏ ﺷﺅﻭﻥ ﺍﻟﻁﻠﺑﺔ ﻭﺗﺳﺣﺏ ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻣﻥ ﻧﻔﺱ ﺍﻟﻣﻛﺗﺏ‪،‬‬
‫ﺑﺎﺳﺗﺛﻧﺎء ﻣﻁﺎﻟﺏ*‪ :‬ﺗﺄﺟﻳﻝ ﺍﻟﺗﺭﺳﻳﻡ ‪ /‬ﺍﻟﻧﻘﻠﺔ ﺃﻭ ﺍﻟﻣﻧﺎﻗﻠﺔ ‪ /‬ﺍﻻﻁﻼﻉ ﻋﻠﻰ ﻭﺭﻗﺔ ﺍﻻﻣﺗﺣﺎﻥ ‪ /‬ﺗﺣﺻﻳﻝ ﺃﺭﺻﺩﺓ ‪ /‬ﻣﻁﻠﺏ ﻣﺳﺎﻋﺩﺓ‬
‫ﺧﺎﺹ ﺑﺎﻟﻁﻠﺑﺔ ﺫﻭﻱ ﺍﻻﺣﺗﻳﺎﺟﺎﺕ ﺍﻟﺧﺎﺻﺔ‬
‫ﺍﻟﺗﻲ ﺗﻭﺩﻉ ﻭﺟﻭﺑﺎ ﺑﻣﻛﺗﺏ ﺍﻟﺿﺑﻁ‪.‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-02‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﺷﻬﺎﺩﺓ ﺣﺿﻭﺭ‬

‫)ﺿﻊ ﻋﻼﻣﺔ ‪ X‬ﻓﻲ ﺍﻟﺧﺎﻧﺔ ﺍﻟﻣﻧﺎﺳﺑﺔ(‬

‫ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺭﻧﺳﻳﺔ‬ ‫□‬ ‫ﺑﺎﻟﻠﻐﺔ ﺍﻟﻌﺭﺑﻳﺔ‬ ‫□‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................ :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬
‫ﺳﺑﺏ ﺍﻟﻣﻁﻠﺏ‪...................................................................................... :‬‬
‫‪..................................................................................................‬‬
‫ﺇﻣﺿﺎءﺍﺕ ﺍﻟﻣﺩﺭﺳﻳﻥ ﻹﺛﺑﺎﺕ ﺍﻟﺣﺿﻭﺭ ﺍﻟﻔﻌﻠﻲ ﻟﻠﻁﺎﻟﺏ‪:‬‬
‫ﺍﻹﻣﺿﺎء ‪ +‬ﺗﺎﺭﻳﺦ ﺍﻹﻣﺿﺎء‬ ‫ﻣﺎﺩﺓ ﺍﻟﺗﺩﺭﻳﺱ‬ ‫ﺍﺳﻡ ﻭﻟﻘﺏ ﺍﻟﻣﺩﺭﺱ‬ ‫ﻉ‪/‬ﺭ‬

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫________________________________________________________‬
‫ﻣﻼﺣﻅﺎﺕ‪:‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺷﻬﺎﺩﺓ‬ ‫‪ -‬ﻳﻌﺗﺑﺭ ﻻﻏﻳﺎ ﻛﻝ ﻣﻁﻠﺏ ﻻ ﻳﺭﻓﻖ ﺑﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‪) ،‬ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪+‬‬
‫ﺍﻟﺗﺭﺳﻳﻡ(‪.‬‬
‫‪ -‬ﺇﻣﺿﺎء ﺍﻟﻣﺩﺭﺳﻳﻥ ﺑﺎﻟﺟﺩﻭﻝ ﺃﻋﻼﻩ ﺇﺟﺑﺎﺭﻱ‪.‬‬
‫‪ -‬ﺗﺳﻠﻡ ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻏﺿﻭﻥ ﻳﻭﻣﻲ ﻋﻣﻝ ﻣﻥ ﺗﺎﺭﻳﺦ ﺇﻳﺩﺍﻉ ﺍﻟﻣﻁﻠﺏ‪.‬‬
‫‪ -‬ﺑﺎﻟﻧﺳﺑﺔ ﻟﻠﻁﻠﺑﺔ ﺍﻟﺫﻳﻥ ﻫﻡ ﻓﻲ ﻓﺗﺭﺓ ﺗﺭﺑﺹ ﻟﺧﺗﻡ ﺍﻟﺩﺭﺍﺳﺔ‪ ،‬ﺇﻣﺿﺎءﺍﺕ ﺍﻟﻣﺩﺭﺳﻳﻥ ﻏﻳﺭ ﻣﻁﻠﻭﺑﺔ ﻭ ﻋﻠﻳﻬﻡ ﺗﻘﺩﻳﻡ ﻣﺎ ﻳﺛﺑﺕ ﺃﻧﻬﻡ‬
‫ﺑﺻﺩﺩ ﺍﻟﻘﻳﺎﻡ ﺑﺎﻟﺗﺭﺑﺹ ﺍﻟﻣﺫﻛﻭﺭ ‪.‬‬
‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-03‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﺷﻬﺎﺩﺓ ﻣﻐﺎﺩﺭﺓ‬

‫‪+‬‬
‫ﺍﻟﻣﻠﻑ ﺍﻟﻁﺑﻲ ﺍﻟﻣﺩﺭﺳﻲ‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................ :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺳﺑﺏ ﺍﻟﻣﻁﻠﺏ‪) :‬ﺿﻊ ﻋﻼﻣﺔ ‪ X‬ﻓﻲ ﺍﻟﺧﺎﻧﺔ ﺍﻟﻣﻧﺎﺳﺑﺔ(‬

‫ﺍﻟﻧﺟﺎﺡ ﻓﻲ ﻣﻧﺎﻅﺭﺓ ﺇﻋﺎﺩﺓ ﺍﻟﺗﻭﺟﻳﻪ‬ ‫□‬

‫ﺍﻟﻧﻘﻠﺔ ﺇﻟﻰ ﻣﺅﺳﺳﺔ ﺃﺧﺭﻯ – ﺍﺳﻡ ﺍﻟﻣﺅﺳﺳﺔ‪................................................... :‬‬ ‫□‬
‫‪ ……………..‬ﻓﻲ ‪............... :‬‬
‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‬ ‫‪-‬‬
‫ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ ﺍﻷﺻﻠﻳﺔ ﻟﻠﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ ﺍﻟﺣﺎﻟﻳﺔ‬ ‫‪-‬‬
‫ﺷﻬﺎﺩﺓ ﺗﺛﺑﺕ ﺍﻟﻧﻘﻠﺔ ﺇﻟﻰ ﻣﺅﺳﺳﺔ ﺃﺧﺭﻯ ﺃﻭ ﺍﻟﻧﺟﺎﺡ ﻓﻲ ﻣﻧﺎﻅﺭﺓ ﺇﻋﺎﺩﺓ ﺍﻟﺗﻭﺟﻳﻪ‬ ‫‪-‬‬
‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫‪ -‬ﺗﺳﻠﻡ ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻏﺿﻭﻥ ﻳﻭﻣﻲ ﻋﻣﻝ ﻣﻥ ﺗﺎﺭﻳﺦ ﺇﻳﺩﺍﻉ ﺍﻟﻣﻁﻠﺏ‪.‬‬
‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-04‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﻧﻅﻳﺭ ﻣﻥ ﻭﺛﻳﻘﺔ ﺇﺩﺍﺭﻳﺔ‬

‫)ﺿﻊ ﻋﻼﻣﺔ ‪ X‬ﻓﻲ ﺍﻟﺧﺎﻧﺔ ﺍﻟﻣﻧﺎﺳﺑﺔ(‬

‫□‬
‫ﺷﻬﺎﺩﺓ ﺗﺭﺳﻳﻡ‬
‫□ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‬
‫□ ﻛﺷﻑ ﺃﻋﺩﺍﺩ ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‪..................................... :‬‬
‫□ ﺷﻬﺎﺩﺓ ﺍﻟﺗﺧﺭﺝ‪................................................. :‬‬
‫□ ﻭﺛﻳﻘﺔ ﺃﺧﺭﻯ‪................................................... :‬‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................. :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬
‫ﺳﺑﺏ ﺍﻟﻣﻁﻠﺏ‪...................................................................................... :‬‬

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‬ ‫‪-‬‬
‫ﺷﻬﺎﺩﺓ ﺿﻳﺎﻉ‬ ‫‪-‬‬
‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫‪ -‬ﺗﺳﻠﻡ ﺍﻟﻭﺛﻳﻘﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻏﺿﻭﻥ ﻋﺷﺭﺓ ﺃﻳﺎﻡ ﻋﻣﻝ ﻣﻥ ﺗﺎﺭﻳﺦ ﺇﻳﺩﺍﻉ ﺍﻟﻣﻁﻠﺏ‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-05‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺇﺻﻼﺡ ﻭﺛﻳﻘﺔ ﺇﺩﺍﺭﻳﺔ‬

‫)ﺿﻊ ﻋﻼﻣﺔ ‪ X‬ﻓﻲ ﺍﻟﺧﺎﻧﺔ ﺍﻟﻣﻧﺎﺳﺑﺔ(‬

‫□‬
‫ﺷﻬﺎﺩﺓ ﺗﺭﺳﻳﻡ‬

‫□ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‬

‫□ ﻛﺷﻑ ﺃﻋﺩﺍﺩ ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‪..................................... :‬‬

‫□ ﺷﻬﺎﺩﺓ ﺍﻟﺗﺧﺭﺝ‪................................................. :‬‬

‫□ ﻭﺛﻳﻘﺔ ﺃﺧﺭﻯ‪................................................... :‬‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................. :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺍﻟﺧﻁﺄ ﻳﻛﻣﻥ ﻓﻲ‪.................................................................................... :‬‬

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬
‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‬ ‫‪-‬‬
‫ﺍﻷﺻﻝ ﻣﻥ ﺍﻟﻭﺛﻳﻘﺔ ﺍﻟﻣﺭﺍﺩ ﺇﺻﻼﺡ ﻣﺣﺗﻭﺍﻫﺎ‬ ‫‪-‬‬
‫ﻣﺿﻣﻭﻥ ﻭﻻﺩﺓ ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺭﻧﺳﻳﺔ ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺟﻭﺍﺯ ﺍﻟﺳﻔﺭ ﻓﻲ ﺣﺎﻟﺔ ﺇﺻﻼﺡ ﻭﺛﻳﻘﺔ ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺭﻧﺳﻳﺔ‬ ‫‪-‬‬
‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫‪ -‬ﺗﺳﻠﻡ ﺍﻟﻭﺛﻳﻘﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻏﺿﻭﻥ ﻋﺷﺭﺓ ﺃﻳﺎﻡ ﻋﻣﻝ ﻣﻥ ﺗﺎﺭﻳﺦ ﺇﻳﺩﺍﻉ ﺍﻟﻣﻁﻠﺏ‪.‬‬
‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-06‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺗﺄﺟﻳﻝ ﺍﻟﺗﺭﺳﻳﻡ‬

‫ﺻﺣﻲ‬ ‫□‬ ‫ﺷﺧﺻﻲ‬ ‫□‬ ‫ﺳﺑﺏ ﻁﻠﺏ ﺍﻟﺗﺄﺟﻳﻝ‪:‬‬

‫ﻻ‬‫□‬ ‫ﻧﻌﻡ‬ ‫ﺳﺑﻖ ﺍﻻﻧﺗﻔﺎﻉ ﺑﺗﺄﺟﻳﻝ ﺍﻟﺗﺭﺳﻳﻡ ﻷﺳﺑﺎﺏ ﺷﺧﺻﻳﺔ‪□ :‬‬
‫□ﻻ‬ ‫ﺳﺑﻖ ﺍﻻﻧﺗﻔﺎﻉ ﺑﺗﺄﺟﻳﻝ ﺍﻟﺗﺭﺳﻳﻡ ﻷﺳﺑﺎﺏ ﺻﺣﻳﺔ‪ □ :‬ﻧﻌﻡ‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺗﺎﺭﻳﺦ ﻭ ﻣﻛﺎﻥ ﺍﻟﻭﻻﺩﺓ‪.............................................................................. :‬‬

‫ﺍﻟﻌﻧﻭﺍﻥ ﺍﻟﻘﺎﺭ‪....................................................................................... :‬‬
‫ﺍﻟﻬﺎﺗﻑ‪.......................................................... :‬‬

‫‪ ................‬ﻓﻲ ‪..................:‬‬
‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‬ ‫‪-‬‬
‫ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ ﺍﻷﺻﻠﻳﺔ‬ ‫‪-‬‬
‫ﺷﻬﺎﺩﺓ ﻁﺑﻳﺔ ﻓﻲ ﻅﺭﻑ ﻣﻐﻠﻖ )ﺧﺎﺻﺔ ﺑﻣﻁﺎﻟﺏ ﺗﺄﺟﻳﻝ ﺍﻟﺗﺭﺳﻳﻡ ﻷﺳﺑﺎﺏ ﺻﺣﻳﺔ(‬ ‫‪-‬‬
‫________________________________________________________‬
‫ﻣﻼﺣﻅﺎﺕ‪:‬‬
‫‪ -‬ﻳﻌﺗﺑﺭ ﻻﻏﻳﺎ ﻛﻝ ﻣﻁﻠﺏ ﺗﺄﺟﻳﻝ ﺍﻟﺗﺭﺳﻳﻡ ﻷﺳﺑﺎﺏ ﺷﺧﺻﻳﺔ ﻳﺭﺩ ﺑﻌﺩ ‪ 30‬ﻳﻭﻡ ﻣﻥ ﺍﻓﺗﺗﺎﺡ ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‪.‬‬
‫‪ -‬ﻓﻲ ﺻﻭﺭﺓ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻰ ﺍﻟﻣﻭﺍﻓﻘﺔ ﻋﻠﻰ ﺗﺄﺟﻳﻝ ﺍﻟﺗﺭﺳﻳﻡ ﻓﺈﻥ ﺫﻟﻙ ﻳﻛﻭﻥ ﻟﻠﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ ﺍﻟﻣﻌﻧﻳﺔ ﻓﻘﻁ‪.‬‬
‫‪ -‬ﻳﺳﺗﻅﻬﺭ ﺍﻟﻣﻌﻧﻲ ﺑﺎﻷﻣﺭ ﻓﻲ ﻣﻔﺗﺗﺢ ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ ﺍﻟﻣﻭﺍﻟﻳﺔ ﺑﺷﻬﺎﺩﺓ ﺗﺛﺑﺕ ﺷﻔﺎءﻩ ﻣﻥ ﺍﻟﻣﺭﺽ ﺇﻥ ﻛﺎﻥ ﺍﻟﺗﺄﺟﻳﻝ ﻷﺳﺑﺎﺏ ﺻﺣﻳﺔ‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-07‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺗﺛﻣﻳﻥ ﺍﻟﻭﺣﺩﺍﺕ‬

‫)ﺿﻊ ﻋﻼﻣﺔ ‪ X‬ﻓﻲ ﺍﻟﺧﺎﻧﺔ ﺍﻟﻣﻧﺎﺳﺑﺔ(‬

‫□‬
‫ﻁﺎﻟﺏ ﺭﺍﺳﺏ ﺑﺎﻟﻣﻌﻬﺩ‬

‫□ ﻁﺎﻟﺏ ﻗﺎﺩﻡ ﻣﻥ ﻣﺅﺳﺳﺔ ﺃﺧﺭﻯ‬

‫□ ﻁﺎﻟﺏ ﻣﻧﺗﻔﻊ ﺑﺗﻌﺩﻳﻝ ﺍﻟﻣﺳﺎﺭ‬

‫ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ ﺍﻟﺣﺎﻟﻳﺔ‪....... /....... :‬‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ ﺍﻟﺣﺎﻟﻲ‪......................................................................... :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪......................................................................................... :‬‬

‫‪......... / .........‬‬ ‫ﺃﺭﻏﺏ ﻓﻲ ﺗﺛﻣﻳﻥ ﻭﺣﺩﺍﺕ ﺍﻟﺗﺩﺭﻳﺱ ﺍﻟﻣﺗﻌﻠﻘﺔ ﺑﺂﺧﺭ ﺳﻧﺔ ﺟﺎﻣﻌﻳﺔ ﺩﺭﺳﺗﻬﺎ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ ‪................................................................................ :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺍﻟﻣﺅﺳﺳﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ ‪............................................................................... :‬‬

‫‪ ................‬ﻓﻲ ‪..................:‬‬
‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬
‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‬
‫‪ -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻷﻋﺩﺍﺩ ﻵﺧﺭ ﺳﻧﺔ ﺟﺎﻣﻌﻳﺔ ﺩﺭﺳﻬﺎ ﺍﻟﻁﺎﻟﺏ‬
‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫ﻻ ﻳﻧﺗﻔﻊ ﻁﻠﺑﺔ ﺍﻟﻣﺭﺣﻠﺔ ﺍﻟﺗﺣﺿﻳﺭﻳﺔ ﺍﻟﺫﻳﻥ ﺍﻧﺗﻘﻠﻭﺍ ﺇﻟﻰ ﻧﻅﺎﻡ ﺇ‪.‬ﻡ‪.‬ﺩ ﺑﺗﺛﻣﻳﻥ ﺍﻟﻭﺣﺩﺍﺕ‪.‬‬ ‫‪-‬‬
‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫‪Code : FR-PAE-08‬‬
‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬
‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬
‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬
‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻟﻼﻁﻼﻉ ﻋﻠﻰ ﻭﺭﻗﺔ ﺍﻻﻣﺗﺣﺎﻥ‬

‫ﺇﻧﻲ ﺍﻟﻣﻣﺿﻲ ﺃﺳﻔﻠﻪ ﺍﻟﻁﺎﻟﺏ‪:‬‬
‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫□□□□□□□□‬ ‫ﺍﻟﻬﺎﺗﻑ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................. :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺃﻁﻠﺏ ﻣﻥ ﺳﻳﺎﺩﺗﻛﻡ ﺍﻹﻁﻼﻉ ﻋﻠﻰ ﻭﺭﻗﺔ ﺍﻻﻣﺗﺣﺎﻥ ‪:‬‬

‫ﺭﺃﻱ ﺍﻷﺳﺗﺎﺫ ﺑﻌﺩ‬

‫ﺍﻟﻌﺩﺩ ﺍﻟﻣﺳﻧﺩ‬ ‫ﺍﻷﺳﺗﺎﺫ ﺍﻟﻣﺷﺭﻑ‬ ‫ﺍﻟﻣﺎﺩﺓ‬ ‫ﻉ‪/‬ﺭ‬
‫ﺍﻟﺗﺛﺑﺕ‬

‫‪01‬‬

‫‪02‬‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‬
‫ﻣﻼﺣﻅﺎﺕ ﻫﺎﻣﺔ‪:‬‬
‫‪ -‬ﻳﺳﺟﻝ ﺍﻟﻣﻁﻠﺏ ﻭﺟﻭﺑﺎ ﺑﻣﻛﺗﺏ ﺍﻟﺿﺑﻁ‪.‬‬
‫‪ -‬ﻳﺳﻣﺢ ﻟﻠﻁﺎﻟﺏ ﺑﺎﻻﻁﻼﻉ ﻋﻠﻰ ﻭﺭﻗﺗﻲ )‪ (2‬ﺍﻣﺗﺣﺎﻥ ﻋﻠﻰ ﺍﻷﻛﺛﺭ‪.‬‬
‫‪ -‬ﻳﺳﻣﺢ ﻟﻠﻁﺎﻟﺏ ﺑﺎﻻﻁﻼﻉ ﻋﻠﻰ ﻭﺭﻗﺔ ﺍﻻﻣﺗﺣﺎﻥ ﻟﻠﺗﺛﺑﺕ ﻓﻲ ﺻﺣﺔ ﺍﻟﻌﺩﺩ ﺍﻟﻣﺳﻧﺩ ﻟﻪ ﻭ ﻛﻝ ﺧﻁﺄ ﻣﺎﺩﻱ ﻳﺳﺗﻭﺟﺏ ﺇﺻﻼﺣﻪ‬
‫ﻋﻠﻰ ﺃﻥ ﻫﺫﻩ ﺍﻹﻣﻛﺎﻧﻳﺔ ﻻ ﺗﻌﻧﻲ ﺇﻋﺎﺩﺓ ﺇﺻﻼﺡ ﻭﺭﻗﺔ ﺍﻻﻣﺗﺣﺎﻥ‪.‬‬
‫‪ -‬ﻻ ﻳﻣﻛﻥ ﻟﻠﻁﺎﻟﺏ ﺍﻟﻣﻁﺎﻟﺑﺔ ﺑﺎﻻﻁﻼﻉ ﻋﻠﻰ ﺍﻷﻭﺭﺍﻕ ﺍﻟﺧﺎﺻﺔ ﺑﻔﺭﻭﺽ ﺍﻟﻣﺭﺍﻗﺑﺔ ﺃﻭ ﺑﺎﻷﺷﻐﺎﻝ ﺍﻟﺗﻁﺑﻳﻘﻳﺔ‪.‬‬
‫‪ -‬ﻻ ﺗﻧﻅﺭ ﺍﻹﺩﺍﺭﺓ ﻓﻲ ﺍﻟﻣﻁﺎﻟﺏ ﺍﻟﻭﺍﺭﺩﺓ ﺑﻌﺩ ﺃﺳﺑﻭﻉ ﻋﻣﻝ ﺍﺑﺗﺩﺍء ﻣﻥ ﺗﺎﺭﻳﺦ ﺍﻹﻋﻼﻥ ﻋﻥ ﺍﻟﻧﺗﺎﺋﺞ‪.‬‬

‫‪ ................‬ﻓﻲ ‪..................:‬‬
‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫___________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-09‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺗﺳﺟﻳﻝ ﺍﺳﺗﺛﻧﺎﺋﻲ‬

‫)ﺿﻊ ﻋﻼﻣﺔ ‪ X‬ﻓﻲ ﺍﻟﺧﺎﻧﺔ ﺍﻟﻣﻧﺎﺳﺑﺔ(‬

‫ﺗﺳﺟﻳﻝ ﺍﺳﺗﺛﻧﺎﺋﻲ ﻟﻼﻣﺗﺣﺎﻧﺎﺕ )ﻁﺎﻟﺏ ﻏﻳﺭ ﻧﻅﺎﻣﻲ( *‬ ‫□‬

‫□ ﺗﺳﺟﻳﻝ ﺍﺳﺗﺛﻧﺎﺋﻲ ﻣﻊ ﺍﻟﺗﺯﺍﻡ )ﻁﺎﻟﺏ ﻧﻅﺎﻣﻲ( **‬
‫ﻓﻲ ﺣﺎﻟﺔ ﻁﻠﺏ ﺗﺳﺟﻳﻝ ﺍﺳﺗﺛﻧﺎﺋﻲ ﻟﻼﻣﺗﺣﺎﻧﺎﺕ‪ ،‬ﻳﻌﺗﺑﺭ ﺍﻟﻁﺎﻟﺏ ﻏﻳﺭ ﻧﻅﺎﻣﻲ ﻭﺑﺫﻟﻙ ﻳﺗﻭﺟﺏ ﻋﻠﻳﻪ ﺍﻟﺣﺿﻭﺭ ﻓﻲ‪ :‬ﺍﻣﺗﺣﺎﻧﺎﺕ ﺁﺧﺭ ﺍﻟﺳﺩﺍﺳﻲ‪،‬‬ ‫*‬
‫ﻓﺭﺽ ﺍﻟﻣﺭﺍﻗﺑﺔ ﻋﺩﺩ ‪ 2‬ﻭﺣﺻﺹ ﺍﻹﺷﻐﺎﻝ ﺍﻟﺗﻁﺑﻳﻘﻳﺔ ﻭﺍﻣﺗﺣﺎﻧﺎﺗﻬﺎ ﺩﻭﻥ ﺳﻭﺍﻫﻡ‪.‬‬

‫ﻳﻌﺗﺑﺭ ﺍﻟﻁﺎﻟﺏ ﺍﻟﻣﻣﺿﻲ ﻋﻠﻰ ﺍﻻﻟﺗﺯﺍﻡ )ﻣﻁﺑﻭﻋﺔ ﻋﺩﺩ ‪ FR‐PAE‐10‬ﺍﻟﻣﺗﻭﻓﺭﺓ ﺑﻣﻭﻗﻊ ﺍﻟﻭﺍﺏ( ﻁﺎﻟﺑﺎ ﻧﻅﺎﻣﻳﺎ ﻭﺑﺎﻟﺗﺎﻟﻲ ﺗﻁﺑﻖ ﻋﻠﻳﻪ‬ ‫**‬
‫ﺟﻣﻳﻊ ﺍﻹﺟﺭﺍءﺍﺕ ﺍﻟﻣﺗﻌﻠﻘﺔ ﺑﺎﻻﻣﺗﺣﺎﻧﺎﺕ ﻭ ﺑﻌﺩﺩ ﺍﻟﻐﻳﺎﺑﺎﺕ ﺍﻟﻣﺳﻣﻭﺡ ﺑﻪ‪ .‬ﻛﻣﺎ ﻳﻠﺗﺯﻡ ﺍﻟﻁﺎﻟﺏ ﺍﻟﻣﻣﺿﻲ ﻋﻠﻰ ﺍﻻﻟﺗﺯﺍﻡ ﺍﻟﻣﺫﻛﻭﺭ ﺑﺎﻟﺣﺿﻭﺭ‬
‫ﻓﻲ ﺟﻣﻳﻊ ﺣﺻﺹ ﺍﻟﺗﺩﺭﻳﺱ ﺍﻟﻣﺑﺭﻣﺟﺔ ﻣﻥ ﺩﺭﻭﺱ ﻭﺃﺷﻐﺎﻝ ﻣﺳﻳﺭﺓ ﻭﺣﺻﺹ ﺍﻷﺷﻐﺎﻝ ﺍﻟﺗﻁﺑﻳﻘﻳﺔ‪ ،‬ﻛﻣﺎ ﻳﻠﺗﺯﻡ ﺑﺈﺟﺭﺍء ﺍﻣﺗﺣﺎﻧﺎﺕ ﻓﺭﻭﺽ‬
‫ﺍﻟﻣﺭﺍﻗﺑﺔ ﻟﻣﺧﺗﻠﻑ ﺍﻟﻣﻭﺍﺩ ﻭﺍﻣﺗﺣﺎﻧﺎﺕ ﻧﻬﺎﻳﺔ ﺍﻟﺳﺩﺍﺳﻳﻳﻥ ﺍﻷﻭﻝ ﻭﺍﻟﺛﺎﻧﻲ ﻟﻠﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ ﺍﻟﻣﻌﻧﻳﺔ‪ .‬ﻭﻳﻭﺩﻉ ﺍﻻﻟﺗﺯﺍﻡ ﻣﻊ ﻣﻠﻑ ﺍﻟﺗﺳﺟﻳﻝ ﻋﻧﺩ ﺍﻟﻘﻳﺎﻡ‬
‫ﺑﺎﻟﺗﺭﺳﻳﻡ ﺍﻹﺩﺍﺭﻱ‪ ،‬ﺑﻌﺩ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻰ ﻣﻭﺍﻓﻘﺔ ﺍﻟﻣﺩﻳﺭ‪.‬‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺍﻟﻬﺎﺗﻑ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪ ................................. :‬ﺍﻻﺧﺗﺻﺎﺹ‪............................................................... :‬‬

‫ﺃﻁﻠﺏ ﻣﻥ ﺳﻳﺎﺩﺗﻛﻡ ﺗﻣﻛﻳﻧﻲ ﻣﻥ ﺗﺳﺟﻳﻝ ﺍﺳﺗﺛﻧﺎﺋﻲ ﻟﻠﻣﺭﺓ‪.................................................................................‬‬

‫ﺍﻟﺩﺭﺍﺳﺎﺕ ﺍﻟﺟﺎﻣﻌﻳﺔ ﺑﻌﺩ ﺍﻟﺑﺎﻛﺎﻟﻭﺭﻳﺎ‪:‬‬
‫ﺍﻟﻧﺗﻳﺟﺔ‬ ‫ﺍﻻﺧﺗﺻﺎﺹ‬ ‫ﺍﻟﻣﺳﺗﻭﻯ‬ ‫ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‬ ‫ﻉ‪/‬ﺭ‬
‫‪1‬‬
‫‪2‬‬
‫‪3‬‬
‫‪4‬‬
‫‪5‬‬
‫‪6‬‬

‫‪ ................‬ﻓﻲ‪.................. :‬‬ ‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬ ‫ﺭﺃﻱ ﺍﻟﻣﺩﻳﺭ‬ ‫ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‬ ‫‪-‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-10‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺍﺳﺗﺧﺭﺍﺝ ﺷﻬﺎﺩﺓ ﻧﺟﺎﺡ‬

‫)ﺿﻊ ﻋﻼﻣﺔ ‪ X‬ﻓﻲ ﺍﻟﺧﺎﻧﺔ ﺍﻟﻣﻧﺎﺳﺑﺔ(‬

‫ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺭﻧﺳﻳﺔ‬ ‫□‬ ‫ﺑﺎﻟﻠﻐﺔ ﺍﻟﻌﺭﺑﻳﺔ‬ ‫□‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﺗﺩﺍﺭﻙ‬ ‫□‬ ‫ﺍﻟﺭﺋﻳﺳﻳﺔ‬ ‫□‬ ‫ﺍﺟﺗﺯﺕ ﺑﻧﺟﺎﺡ ﺍﻣﺗﺣﺎﻧﺎﺕ ﺍﻟﺩﻭﺭﺓ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ ﺍﻟﺧﺎﺹ ﺑﺷﻬﺎﺩﺓ ﺍﻟﻧﺟﺎﺡ ﺍﻟﻣﻁﻠﻭﺑﺔ‪............................................... :‬‬

‫ﺍﺧﺗﺻﺎﺹ‪......................................................................................... :‬‬

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-11‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺍﺳﺗﺧﺭﺍﺝ ﻛﺷﻑ ﺃﻋﺩﺍﺩ‬

‫ﺑﺎﻷﺭﺻﺩﺓ )‪(avec crédits‬‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................. :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺃﻁﻠﺏ ﻣﻥ ﺳﻳﺎﺩﺗﻛﻡ ﺗﻣﻛﻳﻧﻲ ﻣﻥ ﺍﺳﺗﺧﺭﺍﺝ ﻛﺷﻑ ﺃﻋﺩﺍﺩ ﺑﺎﻷﺭﺻﺩﺓ )‪(avec crédits‬‬

‫ﻟﻠﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‪....../...... :‬‬

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‪.‬‬

‫‪ -‬ﺑﻁﺎﻗﺔ ﺃﻋﺩﺍﺩ ﺃﺻﻠﻳﺔ ‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-12‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺍﺳﺗﺧﺭﺍﺝ ﻛﺷﻑ ﺃﻋﺩﺍﺩ‬

‫ﺑﺎﻟﺭﺗﺑﺔ )‪(avec rang‬‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................. :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺃﻁﻠﺏ ﻣﻥ ﺳﻳﺎﺩﺗﻛﻡ ﺗﻣﻛﻳﻧﻲ ﻣﻥ ﺍﺳﺗﺧﺭﺍﺝ ﻛﺷﻑ ﺃﻋﺩﺍﺩ ﺑﺎﻟﺭﺗﺑﺔ )‪(avec rang‬‬

‫ﻟﻠﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‪....../...... :‬‬

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‬

‫‪ -‬ﺑﻁﺎﻗﺔ ﺃﻋﺩﺍﺩ ﺃﺻﻠﻳﺔ‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-13‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﺍﻟﺗﺯﺍﻡ‬
‫)ﺧﺎﺹ ﺑﺎﻟﺣﺎﺻﻠﻳﻥ ﻋﻠﻰ ﺗﺳﺟﻳﻝ ﺍﺳﺗﺛﻧﺎﺋﻲ(‬

‫ﺇﻧﻲ ﺍﻟﻣﻣﺿﻲ ﺃﺳﻔﻠﻪ ﺍﻟﻁﺎﻟﺏ‪:‬‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺟﻝ ﺗﺳﺟﻳﻼ ﺍﺳﺗﺛﻧﺎﺋﻳﺎ ﻟﻠﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‪......./....... :‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................ :‬‬
‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺃﻟﺗﺯﻡ ﺑﺎﻟﺣﺿﻭﺭ ﻓﻲ ﺟﻣﻳﻊ ﺣﺻﺹ ﺍﻟﺗﺩﺭﻳﺱ ﺍﻟﻣﺑﺭﻣﺟﺔ ﻣﻥ ﺩﺭﻭﺱ ﻭ ﺃﺷﻐﺎﻝ ﻣﺳﻳﺭﺓ ﻭ ﺣﺻﺹ ﺍﻷﺷﻐﺎﻝ‬
‫ﺍﻟﺗﻁﺑﻳﻘﻳﺔ‪ ،‬ﻛﻣﺎ ﺃﻟﺗﺯﻡ ﺑﺈﺟﺭﺍء ﺍﻣﺗﺣﺎﻧﺎﺕ ﻓﺭﻭﺽ ﺍﻟﻣﺭﺍﻗﺑﺔ ﻟﻣﺧﺗﻠﻑ ﺍﻟﻣﻭﺍﺩ ﻭ ﺍﻣﺗﺣﺎﻧﺎﺕ ﻧﻬﺎﻳﺔ ﺍﻟﺳﺩﺍﺳﻳﻳﻥ ﺍﻷﻭﻝ‬
‫ﻭ ﺍﻟﺛﺎﻧﻲ ﻟﻠﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ ﺍﻟﻣﺫﻛﻭﺭﺓ ﺃﻋﻼﻩ‪.‬‬

‫ﻣﻼﺣﻅﺎﺕ ﻫﺎﻣﺔ‪:‬‬
‫‪ -‬ﻫﺫﺍ ﺍﻹﻟﺗﺯﺍﻡ ﻏﻳﺭ ﺇﺟﺑﺎﺭﻱ‪ .‬ﺇﺫﺍ ﻟﻡ ﻳﻘﻊ ﺗﻘﺩﻳﻡ ﻫﺫﺍ ﺍﻻﻟﺗﺯﺍﻡ ﺧﻼﻝ ﻋﻣﻠﻳﺔ ﺍﻟﺗﺭﺳﻳﻡ ﻓﺈﻥ ﺍﻟﻁﺎﻟﺏ ﻳﻌﺗﺑﺭ ﻏﻳﺭ ﻧﻅﺎﻣﻲ ﻭ ﺑﺫﻟﻙ‬
‫ﻳﺗﻭﺟﺏ ﻋﻠﻳﻪ ﺍﻟﺣﺿﻭﺭ ﻓﻲ‪ :‬ﺍﻣﺗﺣﺎﻧﺎﺕ ﺁﺧﺭ ﺍﻟﺳﺩﺍﺳﻲ‪ ،‬ﻓﺭﺽ ﺍﻟﻣﺭﺍﻗﺑﺔ ﻋﺩﺩ ‪ 2‬ﻭ ﺣﺻﺹ ﺍﻹﺷﻐﺎﻝ ﺍﻟﺗﻁﺑﻳﻘﻳﺔ ﻭ ﺍﻣﺗﺣﺎﻧﺎﺗﻬﺎ ﺩﻭﻥ‬
‫ﺳﻭﺍﻫﻡ‪.‬‬
‫‪ -‬ﻳﻌﺗﺑﺭ ﺍﻟﻁﺎﻟﺏ ﺍﻟﻣﻣﺿﻲ ﻋﻠﻰ ﻫﺫﺍ ﺍﻻﻟﺗﺯﺍﻡ ﻁﺎﻟﺑﺎ ﻧﻅﺎﻣﻳﺎ ﻭﺑﺎﻟﺗﺎﻟﻲ ﺗﻁﺑﻖ ﻋﻠﻳﻪ ﺟﻣﻳﻊ ﺍﻹﺟﺭﺍءﺍﺕ ﺍﻟﻣﺗﻌﻠﻘﺔ ﺑﺎﻻﻣﺗﺣﺎﻧﺎﺕ ﻭ‬
‫ﺑﻌﺩﺩ ﺍﻟﻐﻳﺎﺑﺎﺕ ﺍﻟﻣﺳﻣﻭﺡ ﺑﻪ‪.‬‬

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ ﻣﻌﺭﻓﺎ ﺑﻪ‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-14‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﺗﺼﺮﻳﺢ )ﻻﺳﺘﻼﻡ ﺍﻟﺪﻓﺘﺮ ﺍﻟﺼﺤﻲ(‬

‫……‪……/‬‬

‫ﺇﻧﻲ ﺍﻟﻤﻤﻀﻲ ﺃﺳﻔﻠﻪ ﺍﻟﻄﺎﻟﺐ‪.................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺻﺎﺣﺐ ﺏ‪.‬ﺕ‪.‬ﻭ ﺭﻗﻢ ‪:‬‬

‫ﺃﺻﺮﺡ ﺑﺄﻧﻲ ﺗﺴﻠﻤﺖ ﻣﻠﻔﻲ ﺍﻟﻄﺒﻲ ﺍﻟﻤﺪﺭﺳﻲ‪.‬‬

‫‪ ...............‬ﻓﻲ ‪..................:‬‬
‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫………………‪.........................................................................................................‬‬

‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-14‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﺗﺼﺮﻳﺢ )ﻻﺳﺘﻼﻡ ﺍﻟﺪﻓﺘﺮ ﺍﻟﺼﺤﻲ(‬

‫……‪……/‬‬

‫ﺇﻧﻲ ﺍﻟﻤﻤﻀﻲ ﺃﺳﻔﻠﻪ ﺍﻟﻄﺎﻟﺐ‪.................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺻﺎﺣﺐ ﺏ‪.‬ﺕ‪.‬ﻭ ﺭﻗﻢ ‪:‬‬

‫ﺃﺻﺮﺡ ﺑﺄﻧﻲ ﺗﺴﻠﻤﺖ ﻣﻠﻔﻲ ﺍﻟﻄﺒﻲ ﺍﻟﻤﺪﺭﺳﻲ‪.‬‬

‫‪ ...............‬ﻓﻲ ‪..................:‬‬
‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-15‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻧﻘﻠﺔ ﺑﻳﻥ ﺍﻷﻓﻭﺍﺝ‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................. :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺍﻟﻔﻭﺝ ﺍﻟﺣﺎﻟﻲ‪...................................................................................... :‬‬

‫ﺍﻟﻔﻭﺝ ﺍﻟﻣﻁﻠﻭﺏ‪.................................................................................... :‬‬

‫ﺳﺑﺏ ﺍﻟﻣﻁﻠﺏ‪...................................................................................... :‬‬

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

‫‪ ................‬ﻓﻲ ‪..................:‬‬

‫ﺍﻹﻣﺿﺎء‬ ‫ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬

‫ﺍﻟﻣﺩﻳﺭ ‪ /‬ﺍﻟﻛﺎﺗﺏ ﺍﻟﻌﺎﻡ‬ ‫ﻋﺩﻡ ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬
‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-16‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻣﻧﺎﻗﻠﺔ ﺑﻳﻥ ﺍﻷﻓﻭﺍﺝ‬

‫ﺍﻟﻁﺎﻟﺏ ﺍﻟﺛﺎﻧﻲ‬ ‫ﺍﻟﻁﺎﻟﺏ ﺍﻷﻭﻝ‬

‫‪...............................................................‬‬ ‫ﺭﻗﻡ ﺏ‪.‬ﺕ‪.‬ﻭ‪:‬‬ ‫‪.....................................................................‬‬ ‫ﺭﻗﻡ ﺏ‪.‬ﺕ‪.‬ﻭ‪:‬‬

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

‫‪...................................................‬‬ ‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪:‬‬ ‫‪..........................................................‬‬ ‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪:‬‬

‫‪................................................................‬‬ ‫ﺍﻻﺧﺗﺻﺎﺹ‪:‬‬ ‫‪........................................................................‬‬ ‫ﺍﻻﺧﺗﺻﺎﺹ‪:‬‬

‫‪.......................................................................‬‬ ‫ﺍﻟﻔﻭﺝ‪:‬‬ ‫‪....................................................................................‬‬ ‫ﺍﻟﻔﻭﺝ‪:‬‬

‫ﺍﻹﻣﺿﺎء‪:‬‬ ‫ﺍﻹﻣﺿﺎء‪:‬‬

‫ﺳﺑﺏ ﺍﻟﻣﻁﻠﺏ‪.................................................................................................... :‬‬

‫…‪..............................................................................................................‬‬
‫‪ ................‬ﻓﻲ ‪..................:‬‬

‫ﺍﻹﻣﺿﺎء‬ ‫ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬

‫ﺍﻟﻣﺩﻳﺭ ‪ /‬ﺍﻟﻛﺎﺗﺏ ﺍﻟﻌﺎﻡ‬ ‫ﻋﺩﻡ ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬
‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ ﻟﻠﻁﺭﻓﻳﻥ‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-17‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺍﺳﺗﺧﺭﺍﺝ ﻛﺷﻑ ﺃﻋﺩﺍﺩ‬

‫ﺍﻟﺳﻧﺔ ﺍﻟﺛﺎﻟﺛﺔ ﻣﺳﺗﻣﺭ )‪(Redoublant‬‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................. :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺃﻁﻠﺏ ﻣﻥ ﺳﻳﺎﺩﺗﻛﻡ ﺗﻣﻛﻳﻧﻲ ﻣﻥ ﺍﺳﺗﺧﺭﺍﺝ ﻛﺷﻑ ﺃﻋﺩﺍﺩ ﻟﻠﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‪........../.......... :‬‬

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-18‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺗﺣﺻﻳﻝ ﺃﺭﺻﺩﺓ‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪...................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪................................................................................ :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪........................................................................................ :‬‬

‫ﺃﻁﻠﺏ ﻣﻥ ﺳﻳﺎﺩﺗﻛﻡ ﺗﻣﻛﻳﻧﻲ ﻣﻥ ﺇﻋﺎﺩﺓ ﺇﺟﺭﺍء ﺍﻣﺗﺣﺎﻧﺎﺕ ﺍﻟﻣﻭﺍﺩ ﺍﻟﺗﺎﻟﻳﺔ ﻗﺻﺩ ﺗﺣﺻﻳﻝ ﺍﻷﺭﺻﺩﺓ‪:‬‬

‫ﻣﻌﺩﻝ‬ ‫ﺍﻟﻣﺳﺗﻭﻯ‬ ‫ﺍﻟﺳﺩﺍﺳﻲ‬

‫ﺍﻻﺳﻡ ﺍﻟﻛﺎﻣﻝ ﻟﻠﻣﺎﺩﺓ‬ ‫ﻉ‪/‬ﺭ‬
‫ﺍﻟﻣﺎﺩﺓ‬ ‫ﺍﻟﺩﺭﺍﺳﻲ ﻟﻠﻣﺎﺩﺓ‬ ‫ﻋﺩﺩ‬
‫‪1‬‬

‫‪2‬‬

‫‪3‬‬

‫‪4‬‬

‫‪5‬‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‬
‫‪ -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻷﻋﺩﺍﺩ ﻓﻲ ﺣﺎﻟﺔ ﻁﻠﺏ ﺍﺟﺗﻳﺎﺯ ﺍﻣﺗﺣﺎﻧﺎﺕ ﻟﻣﻭﺍﺩ ﻣﺗﻌﻠﻘﺔ ﺑﺳﻧﺔ ﺩﺭﺍﺳﻳﺔ ﻣﻧﻘﺿﻳﺔ‪.‬‬
‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫‪ -‬ﺗﻭﺩﻉ ﺍﻟﻣﻁﺎﻟﺏ ﻭﺟﻭﺑﺎ ﺑﻣﻛﺗﺏ ﺍﻟﺿﺑﻁ ﺑﻌﺩ ﺍﻟﺗﺻﺭﻳﺢ ﺑﻧﺗﺎﺋﺞ ﺍﻟﺩﻭﺭﺓ ﺍﻟﺭﺋﻳﺳﻳﺔ ﻭ ﻗﺑﻝ ﺛﻼﺛﺔ ﺃﻳﺎﻡ )‪ (3‬ﻋﻣﻝ ﻣﻥ ﺍﻧﻁﻼﻕ‬
‫ﺍﻣﺗﺣﺎﻧﺎﺕ ﺩﻭﺭﺓ ﺍﻟﺗﺩﺍﺭﻙ‪.‬‬

‫‪ ................‬ﻓﻲ ‪..................:‬‬
‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-19‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﺑﻁﺎﻗﺔ ﻭﺿﻌﻳﺔ ﺟﺎﻣﻌﻳﺔ‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪......................................................................................... :‬‬

‫ﻣﻛﺎﻧﻬﺎ‪............................................. :‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻭﻻﺩﺓ‪............................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻌﻧﻭﺍﻥ‪................................................................................................ :‬‬

‫ﺳﻧﺔ ﺍﻟﺑﺎﻛﺎﻟﻭﺭﻳﺎ‪ ............................... :‬ﺍﻟﺷﻌﺑﺔ‪............................................. :‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ ﺍﻟﺣﺎﻟﻲ‪............................................................................ :‬‬

‫ﺍﻻﺧﺗﺻﺎﺹ‪............................................................................................ :‬‬

‫ﺳﺑﺏ ﺍﻟﻣﻁﻠﺏ‪.......................................................................................... :‬‬

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

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪ -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‬

‫‪ -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺃﻋﺩﺍﺩ ﺍﻟﺑﺎﻛﺎﻟﻭﺭﻳﺎ‬

‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫‪ -‬ﺗﺳﻠﻡ ﺍﻟﺑﻁﺎﻗﺔ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻏﺿﻭﻥ ﻳﻭﻣﻲ ﻋﻣﻝ ﻣﻥ ﺗﺎﺭﻳﺦ ﺇﻳﺩﺍﻉ ﺍﻟﻣﻁﻠﺏ‪.‬‬
‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-20‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﺷﻬﺎﺩﺓ ﺇﻓﺎﺩﺓ‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪......................................................................................... :‬‬

‫ﻣﻛﺎﻧﻬﺎ‪............................................. :‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻭﻻﺩﺓ‪............................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻌﻧﻭﺍﻥ‪................................................................................................ :‬‬

‫ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﺗﺣﺻﻝ ﻋﻠﻳﻬﺎ ﻣﻥ ﺍﻟﻣﻌﻬﺩ‪................................................................. :‬‬

‫ﺳﺑﺏ ﺍﻟﻣﻁﻠﺏ‪.......................................................................................... :‬‬

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

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‬ ‫‪-‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﺗﺣﺻﻝ ﻋﻠﻳﻬﺎ ﻣﻥ ﺍﻟﻣﻌﻬﺩ‬ ‫‪-‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺃﻭ ﺑﻁﺎﻗﺎﺕ ﺍﻷﻋﺩﺍﺩ ﻟﺳﻧﺔ ﺃﻭ ﺳﻧﻭﺍﺕ ﺍﻟﺩﺭﺍﺳﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ ﺍﻟﻣﻘﺿّﺎﺓ ﺑﻣﺅﺳﺳﺔ ﺃﺧﺭﻯ‬ ‫‪-‬‬
‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫‪ -‬ﺗﺳﻠﻡ ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻏﺿﻭﻥ ﺳﺗﺔ ﺃﻳﺎﻡ ﻋﻣﻝ ﻣﻥ ﺗﺎﺭﻳﺦ ﺇﻳﺩﺍﻉ ﺍﻟﻣﻁﻠﺏ‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-21‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻣﺳﺎﻋﺩﺓ ﺧﺎﺹ ﺑﺎﻟﻁﻠﺑﺔ ﺫﻭﻱ ﺍﻻﺣﺗﻳﺎﺟﺎﺕ ﺍﻟﺧﺎﺻﺔ‬

‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪......................................................................................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺭﻗﻡ ﺍﻟﻬﺎﺗﻑ‪................................................................................................ :‬‬

‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ‪........................................................................................ :‬‬

‫ﺍﻟﺷﻌﺑﺔ ﻭ ﺍﻻﺧﺗﺻﺎﺹ‪..................................................................................... :‬‬

‫ﺍﻟﻣﺳﺎﻋﺩﺓ ﺍﻟﻣﻁﻠﻭﺑﺔ‪.......................................................................................... :‬‬

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

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ‬

‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫‪ -‬ﺗﺳﻠﻡ ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻏﺿﻭﻥ ﻳﻭﻣﻲ ﻋﻣﻝ ﻣﻥ ﺗﺎﺭﻳﺦ ﺇﻳﺩﺍﻉ ﺍﻟﻣﻁﻠﺏ‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-22‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺑﻌﺙ ﻧﺎﺩﻱ ﻁﻼﺑﻲ‬

‫‪/‬‬
‫‪............................... ..........................‬‬ ‫ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‬

‫ﺍﺳﻡ ﺍﻟﻧﺎﺩﻱ‪..................................................................................................... :‬‬

‫ﻧﺷﺎﻁ ﺁﺧﺭ‬ ‫□‬ ‫ﺭﻳﺎﺿﻲ‬ ‫□‬ ‫ﻋﻠﻣﻲ‬ ‫□‬ ‫ﺛﻘﺎﻓﻲ‬ ‫□‬ ‫ﻧﻭﻋﻳﺔ ﺍﻟﻧﺷﺎﻁ‪:‬‬

‫ﻭﺻﻑ ﺍﻟﻧﺷﺎﻁ )ﺫﻛﺭ ‪ 3‬ﺃﻧﺷﻁﺔ ﺃﺳﺎﺳﻳﺔ ﻳﻣﺗﺎﺯ ﺑﻬﺎ ﺍﻟﻧﺎﺩﻱ(‪:‬‬

‫‪....................................................................................................................‬‬
‫‪....................................................................................................................‬‬
‫ﺍﺳﻡ ﺍﻟﻁﺎﻟﺏ ﺭﺋﻳﺱ ﺍﻟﻧﺎﺩﻱ‪...................................................................................... :‬‬
‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ ﻭﺍﻟﺷﻌﺑﺔ‪.................................................................................... :‬‬
‫ﺍﻟﻬﺎﺗﻑ‪...................... :‬‬ ‫ﺭﻗﻡ ﺍﻟﺗﺳﺟﻳﻝ‪....................... :‬‬ ‫ﺭﻗﻡ ﺏ‪.‬ﺕ‪.‬ﻭ‪..................... :‬‬
‫ﺍﺳﻡ ﺍﻷﺳﺗﺎﺫ ﺍﻟﻣﺷﺭﻑ ﻋﻠﻰ ﺍﻟﻧﺎﺩﻱ‪............................................................................. :‬‬
‫‪ .................................‬ﺇﻧﺎﺙ‬ ‫‪+‬‬ ‫ﻋﺩﺩ ﺍﻟﻣﺷﺎﺭﻛﻳﻥ ﺍﻟﻘﺎﺭﻳﻥ‪ ............................. :‬ﺫﻛﻭﺭ‬
‫ﺍﻟﻬﻳﺋﺔ ﺍﻟﻣﺳﺅﻭﻟﺔ ﻣﻥ ﺍﻟﻁﻠﺑﺔ ﻋﻠﻰ ﺍﻟﻧﺎﺩﻱ ﺩﻭﻥ ﺍﺣﺗﺳﺎﺏ ﺭﺋﻳﺱ ﺍﻟﻧﺎﺩﻱ‪:‬‬
‫ﺍﻹﻣﺿﺎء‬ ‫ﺍﻟﻬﺎﺗﻑ‬ ‫ﺭﻗﻡ ﺏ‪.‬ﺕ‪ .‬ﻭ‬ ‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ ﻭﺍﻟﺷﻌﺑﺔ‬ ‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‬

‫ﺇﻣﺿﺎء ﺍﻷﺳﺗﺎﺫ ﺍﻟﻣﺷﺭﻑ‬ ‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ ﺭﺋﻳﺱ ﺍﻟﻧﺎﺩﻱ‬

‫‪......................................‬‬ ‫ﺳﻭﺳﺔ ﻓﻲ‬ ‫‪...........................‬‬ ‫‪..............................‬‬

‫ﺍﻹﻣﺿﺎء‬ ‫ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬

‫ﺍﻟﻣﺩﻳﺭ ‪ /‬ﺍﻟﻛﺎﺗﺏ ﺍﻟﻌﺎﻡ‬ ‫ﻋﺩﻡ ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬
‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ ‪ +‬ﻧﺳﺧﺔ ﻣﻥ ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ ﻟﺟﻣﻳﻊ ﺃﻋﺿﺎء ﺍﻟﻬﻳﺋﺔ ﺍﻟﻣﺳﺅﻭﻟﺔ(‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-23‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺗﺟﺩﻳﺩ ﻧﺎﺩﻱ ﻁﻼﺑﻲ‬

‫‪/‬‬
‫‪............................... ..........................‬‬ ‫ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‬
‫ﺍﺳﻡ ﺍﻟﻧﺎﺩﻱ‪....................................................................................................... :‬‬
‫ﺍﺳﻡ ﺍﻟﻁﺎﻟﺏ ﺭﺋﻳﺱ ﺍﻟﻧﺎﺩﻱ‪...................................................................................... :‬‬
‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ ﻭﺍﻟﺷﻌﺑﺔ‪.................................................................................... :‬‬
‫ﺍﻟﻬﺎﺗﻑ‪...................... :‬‬ ‫ﺭﻗﻡ ﺍﻟﺗﺳﺟﻳﻝ‪....................... :‬‬ ‫ﺭﻗﻡ ﺏ‪.‬ﺕ‪.‬ﻭ‪..................... :‬‬
‫ﺍﺳﻡ ﺍﻷﺳﺗﺎﺫ ﺍﻟﻣﺷﺭﻑ ﻋﻠﻰ ﺍﻟﻧﺎﺩﻱ‪............................................................................. :‬‬
‫‪ .......................‬ﺇﻧﺎﺙ‬ ‫‪+‬‬ ‫ﻋﺩﺩ ﺍﻟﻣﺷﺎﺭﻛﻳﻥ ﺍﻟﻘﺎﺭﻳﻥ‪ .................... :‬ﺫﻛﻭﺭ‬

‫ﺍﻟﻬﻳﺋﺔ ﺍﻟﻣﺳﺅﻭﻟﺔ ﻣﻥ ﺍﻟﻁﻠﺑﺔ ﻋﻠﻰ ﺍﻟﻧﺎﺩﻱ ﺩﻭﻥ ﺍﺣﺗﺳﺎﺏ ﺭﺋﻳﺱ ﺍﻟﻧﺎﺩﻱ‪:‬‬

‫ﺍﻹﻣﺿﺎء‬ ‫ﺍﻟﻬﺎﺗﻑ‬ ‫ﺭﻗﻡ ﺏ‪.‬ﺕ‪.‬ﻭ‬ ‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﺩﺭﺍﺳﻲ ﻭﺍﻟﺷﻌﺑﺔ‬ ‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‬

‫ﺃﻫﻡ ﺍﻷﻧﺷﻁﺔ ﺍﻟﻣﻧﺟﺯﺓ ﺧﻼﻝ ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ ﺍﻟﻔﺎﺭﻁﺔ‪:‬‬

‫ﺍﻟﻧﺷﺎﻁ ﺍﻟﻣﻧﺟﺯ )ﻣﺳﺎﺑﻘﺔ‪ ،‬ﻧﺷﺎﻁ ﺗﺭﻓﻳﻬﻲ‪ ،‬ﺗﺣﺳﻳﺳﻲ‪(..... ،‬‬ ‫ﺍﻟﻣﻛﺎﻥ‬ ‫ﺍﻟﺗﺎﺭﻳﺦ‬

‫ﺇﻣﺿﺎء ﺍﻷﺳﺗﺎﺫ ﺍﻟﻣﺷﺭﻑ‬ ‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ ﺭﺋﻳﺱ ﺍﻟﻧﺎﺩﻱ‬

‫‪......................................‬‬ ‫ﺳﻭﺳﺔ ﻓﻲ‬ ‫‪...........................‬‬ ‫‪..............................‬‬

‫ﺍﻹﻣﺿﺎء‬ ‫ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬

‫ﺍﻟﻣﺩﻳﺭ ‪ /‬ﺍﻟﻛﺎﺗﺏ ﺍﻟﻌﺎﻡ‬ ‫ﻋﺩﻡ ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬
‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ ‪ +‬ﻧﺳﺧﺔ ﻣﻥ ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ ﻟﺟﻣﻳﻊ ﺃﻋﺿﺎء ﺍﻟﻬﻳﺋﺔ ﺍﻟﻣﺳﺅﻭﻟﺔ(‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-24‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﻟﻠﻘﻳﺎﻡ ﺑﻧﺷﺎﻁ‬

‫‪/‬‬
‫‪............................... ..........................‬‬ ‫ﺍﻟﺳﻧﺔ ﺍﻟﺟﺎﻣﻌﻳﺔ‬

‫ﺍﺳﻡ ﺍﻟﻧﺎﺩﻱ‪...................................................................................................... :‬‬

‫ﻧﺷﺎﻁ ﺁﺧﺭ‬ ‫□‬ ‫ﺭﻳﺎﺿﻲ‬ ‫□‬ ‫ﻋﻠﻣﻲ‬ ‫□‬ ‫ﺛﻘﺎﻓﻲ‬ ‫□‬ ‫ﻧﻭﻋﻳﺔ ﺍﻟﻧﺷﺎﻁ‪:‬‬
‫ﻭﺻﻑ ﺍﻟﻧﺷﺎﻁ ﻭﺍﻷﻫﺩﺍﻑ ﺍﻟﺭﺋﻳﺳﺔ ﻟﻠﻧﺷﺎﻁ‪:‬‬
‫ﻳﺗﻣﺛﻝ ﺍﻟﻧﺷﺎﻁ ﻓﻲ ‪.................................................................................................‬‬
‫‪....................................................................................................................‬‬
‫ﺃﻫﺩﺍﻑ ﺍﻟﻧﺷﺎﻁ ‪...............................................................................................‬‬
‫‪....................................................................................................................‬‬

‫ﺗﺎﺭﻳﺦ ﻭﺗﻭﻗﻳﺕ ﺑﺩﺍﻳﺔ ﺍﻟﻧﺷﺎﻁ‪.................................................................................. :‬‬

‫ﺗﺎﺭﻳﺦ ﻭﺗﻭﻗﻳﺕ ﺍﻧﺗﻬﺎء ﺍﻟﻧﺷﺎﻁ‪................................................................................ :‬‬

‫ﺍﻟﻣﻛﺎﻥ‪......................................................................................................... :‬‬
‫ﺭﻗﻡ ﺍﻟﻬﺎﺗﻑ‪................................................................................................... :‬‬

‫ﺍﻟﺩﻋﻡ ﺍﻟﻣﻁﻠﻭﺏ‪:‬‬
‫ﺍﻟﻔﺿﺎء‪.......................................................................................................... :‬‬
‫ﺍﻟﻣﻌﺩﺍﺕ ﻭﺍﻟﻠﻭﺍﺯﻡ‪.............................................................................................. :‬‬
‫ﻁﻠﺑﻳﺎﺕ ﺃﺧﺭﻯ‪................................................................................................... :‬‬
‫ﺇﻣﺿﺎء ﺍﻷﺳﺗﺎﺫ ﺍﻟﻣﺷﺭﻑ‬ ‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ ﺭﺋﻳﺱ ﺍﻟﻧﺎﺩﻱ‬
‫‪......................................‬‬ ‫ﺳﻭﺳﺔ ﻓﻲ‬ ‫‪...........................‬‬ ‫‪..............................‬‬

‫ﺍﻹﻣﺿﺎء‬ ‫ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬

‫ﺍﻟﻣﺩﻳﺭ ‪ /‬ﺍﻟﻛﺎﺗﺏ ﺍﻟﻌﺎﻡ‬ ‫ﻋﺩﻡ ﺍﻟﻣﻭﺍﻓﻘﺔ‬ ‫□‬
‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫‪) -‬ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ ‪ +‬ﺷﻬﺎﺩﺓ ﺍﻟﺗﺭﺳﻳﻡ( ﺃﻭ ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﻁﺎﻟﺏ ﻟﻠﻁﺎﻟﺏ ﺭﺋﻳﺱ ﺍﻟﻧﺎﺩﻱ‬
‫‪ -‬ﺍﻟﺑﺭﻧﺎﻣﺞ ﺍﻟﺗﻔﺻﻳﻠﻲ ﻟﻠﻧﺷﺎﻁ ‪ +‬ﻗﺎﺋﻣﺔ ﺍﻟﻁﻠﺑﺔ ﺍﻟﻣﻧﻅﻣﻳﻥ‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-25‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻣﻁﻠﺏ ﺷﻬﺎﺩﺓ ﺗﺛﺑﺕ ﺍﻟﺩﺭﺍﺳﺔ ﺑﺎﻟﻠﻐﺔ ﺍﻟﻔﺭﻧﺳﻳﺔ‬

‫)ﺧﺎﺹ ﺑﺎﻟﻁﻠﺑﺔ ﺍﻟﻣﺗﺧﺭﺟﻳﻥ(‬
‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪......................................................................................... :‬‬
‫ﻣﻛﺎﻧﻬﺎ‪............................................. :‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻭﻻﺩﺓ‪............................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻬﺎﺗﻑ‪................................................................................................ :‬‬
‫ﺍﻟﺑﺭﻳﺩ ﺍﻹﻟﻛﺗﺭﻭﻧﻲ‪..................................................................................... :‬‬
‫ﺍﻟﻌﻧﻭﺍﻥ‪................................................................................................ :‬‬

‫ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﺗﺣﺻﻝ ﻋﻠﻳﻬﺎ ﻣﻥ ﺍﻟﻣﻌﻬﺩ‪................................................................. :‬‬

‫ﺳﺑﺏ ﺍﻟﻣﻁﻠﺏ‪.......................................................................................... :‬‬

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

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪.‬‬ ‫‪-‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﺗﺣﺻﻝ ﻋﻠﻳﻬﺎ ﻣﻥ ﺍﻟﻣﻌﻬﺩ‪.‬‬ ‫‪-‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺁﺧﺭ ﺑﻁﺎﻗﺔ ﺃﻭ ﺑﻁﺎﻗﺎﺕ ﻣﺗﺣﺻﻝ ﻋﻠﻳﻬﺎ ﻣﻥ ﺍﻟﻣﻌﻬﺩ‪.‬‬ ‫‪-‬‬
‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫‪ -‬ﺗﺳﻠﻡ ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻏﺿﻭﻥ ﺳﺗﺔ ﺃﻳﺎﻡ ﻋﻣﻝ ﻣﻥ ﺗﺎﺭﻳﺦ ﺇﻳﺩﺍﻉ ﺍﻟﻣﻁﻠﺏ‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬
 ‫وزارة اﻟﺘﻌﻠﻴﻢ اﻟﻌﺎﱄ واﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬ ‫‪Code : FR-PAE-27‬‬

‫ﺟــﺎﻣﻌﺔ ﺳﻮﺳﺔ‬ ‫‪Révision : 00‬‬

‫اﳌﻌﻬﺪ اﻟﻌﺎﱄ ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺑﺴﻮﺳﺔ‬ ‫‪Date : 24/07/2023‬‬

‫ﻁﻠﺏ ﺍﻟﺑﺭﻧﺎﻣﺞ ﺍﻟﺩﺭﺍﺳﻲ ﺍﻟﺗﻔﺻﻳﻠﻲ‬

‫)ﺧﺎﺹ ﺑﺎﻟﻁﻠﺑﺔ ﺍﻟﻣﺗﺧﺭﺟﻳﻥ(‬
‫ﺍﻻﺳﻡ ﻭﺍﻟﻠﻘﺏ‪......................................................................................... :‬‬
‫ﻣﻛﺎﻧﻬﺎ‪............................................. :‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻭﻻﺩﺓ‪............................... :‬‬

‫□□□□□□□□‬ ‫ﺭﻗﻡ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪:‬‬

‫ﺍﻟﻬﺎﺗﻑ‪................................................................................................ :‬‬
‫ﺍﻟﺑﺭﻳﺩ ﺍﻹﻟﻛﺗﺭﻭﻧﻲ‪..................................................................................... :‬‬
‫ﺍﻟﻌﻧﻭﺍﻥ‪................................................................................................ :‬‬

‫ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﺗﺣﺻﻝ ﻋﻠﻳﻬﺎ ﻣﻥ ﺍﻟﻣﻌﻬﺩ‪................................................................. :‬‬

‫ﺳﺑﺏ ﺍﻟﻣﻁﻠﺏ‪.......................................................................................... :‬‬

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

‫‪ ……………..‬ﻓﻲ ‪............... :‬‬

‫ﺇﻣﺿﺎء ﺍﻟﻁﺎﻟﺏ‬

‫ﺍﻟﻭﺛﺎﺋﻖ ﺍﻟﻣﻁﻠﻭﺑﺔ‪:‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺑﻁﺎﻗﺔ ﺍﻟﺗﻌﺭﻳﻑ ﺍﻟﻭﻁﻧﻳﺔ‪.‬‬ ‫‪-‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﺗﺣﺻﻝ ﻋﻠﻳﻬﺎ ﻣﻥ ﺍﻟﻣﻌﻬﺩ‪.‬‬ ‫‪-‬‬
‫ﻧﺳﺧﺔ ﻣﻥ ﺁﺧﺭ ﺑﻁﺎﻗﺔ ﺃﻋﺩﺍﺩ ﻣﺗﺣﺻﻝ ﻋﻠﻳﻬﺎ ﻣﻥ ﺍﻟﻣﻌﻬﺩ‪.‬‬ ‫‪-‬‬
‫________________________________________________________‬
‫ﻣﻼﺣﻅﺔ‪:‬‬
‫‪ -‬ﺗﺳﻠﻡ ﺍﻟﺷﻬﺎﺩﺓ ﺍﻟﻣﻁﻠﻭﺑﺔ ﻓﻲ ﻏﺿﻭﻥ ﺳﺗﺔ ﺃﻳﺎﻡ ﻋﻣﻝ ﻣﻥ ﺗﺎﺭﻳﺦ ﺇﻳﺩﺍﻉ ﺍﻟﻣﻁﻠﺏ‪.‬‬

‫__________________________________________________________________________________‬
‫ﺍﻟﻌﻨﻮﺍﻥ‪ :‬ﺣﻲ ﺍﻟﻄﻔﺎﻟﺔ ﺍﺑﻦ ﺧﻠﺪﻭﻥ ‪ 4003‬ﺳﻮﺳﺔ ‪ -‬ﺍﻟﻬﺎﺗﻒ ‪ – 216 73 382 656 :‬ﺍﻟﻔﺎﻛﺲ‪216 73 382 658 :‬‬
‫ﻣﻮﻗﻊ ﺍﻟﻮﺍﺏ ‪ - www.issatso.rnu.tn :‬ﺍﻟﻌﻨﻮﺍﻥ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪issatso@issatso.rnu.tn :‬‬