‫ﺍﻟﻤﻁﺒﻭﻉ ﺭﻗﻡ‪4‬‬ ‫ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻤﻐﺮﺑﻴﺔ‬

‫ﻭﺯﺍﺭﺓ ﺍﻟﺘﺮﺑﻴﺔ ﺍﻟﻮﻃﻨﻴﺔ ﻭ ﺍﻟﺘﻌﻠﻴﻢ ﺍﻟﻌﺎﻟﻲ‬

‫ﻭﺗﻜﻮﻳﻦ ﺍﻷﻃﺮ ﻭﺍﻟﺒﺤﺚ ﺍﻟﻌﻠﻤﻲ‬
‫ﻗﻄﺎﻉ ﺍﻟﺘﺮﺑﻴﺔ ﺍﻟﻮﻃﻨﻴﺔ‬
‫ﺍﻷﻛﺎﺩﻳﻤﻴﺔ ﺍﻟﺠﻬﻮﻳﺔ ﻟﻠﺘﺮﺑﻴﺔ ﻭﺍﻟﺘﻜﻮﻳﻦ‬
‫ﻟﻠﺠﻬﺔ ﺍﻟﺸﺮﻗﻴﺔ ﺑﻮﺟﺪﺓ‬
‫ﺍﻟﻨﻴﺎﺑﺔ ﺍﻹﻗﻠﻴﻤﻴﺔ ﺏ‪............................‬‬
‫ﺍﻟﺮﻗﻢ ﺍﻟﻤﺎﻟﻲ‪...................................‬‬ ‫ﻣﺼﻠﺤﺔ ﺍﻟﻤﻮﺍﺭﺩ ﺍﻟﺒﺸﺮﻳﺔ‬
‫ﺍﻟﺒﻄﺎﻗﺔ ﺍﻟﻮﻃﻨﻴﺔ‪...............................‬‬ ‫ﻣﻜﺘﺐ ﺍﻟﺘﻌﻮﻳﻀﺎﺕ ﺍﻟﻌﺎﺋﻠﻴﺔ‬

‫ﺒﻁﺎﻗﺔ ﺘﻘﺩﻴﻡ‬

‫ﺍﻻﺴﻡ ﺍﻟﻌﺎﺌﻠﻲ‪NOM..............................................................................‬‬

‫ﺍﻻﺴﻡ ﺍﻟﺸﺨﺼﻲ‪PRENOM......................................................................‬‬

‫ﺍﻹﻁﺎﺭ‪..............................................................................................‬‬

‫ﻤﻘﺭ ﺍﻟﻌﻤل‪...........................................................................................‬‬

‫ﺍﻟﻤﻭﻀﻭﻉ‪(1):‬‬

‫ﺍﻟﺯﻭﺍﺝ‪-‬ﺍﻟﺭﺠﻌﺔ‪-‬ﺍﻟﻁﻼﻕ‪-‬ﻭﻓﺎ ﺓ ﺍﻟﺯﻭﺝ)ﺓ( ‪ -‬ﻋﺩﻡ ﺸﻐل ﺍﻟﺯﻭﺝ )ﺓ( –ﻤﺘﺎﺒﻌﺔ ﺍﻷﺒﻨﺎﺀ ﻟﻠﺩﺭﺍﺴﺔ‪-‬ﺍﻻﺯﺩﻴﺎﺩ‪-‬‬

‫ﻭﻓﺎﺓ ﺍﻻﺒﻥ)ﺓ( ‪-‬ﺍﻟﺤﻀﺎﻨﺔ‪-‬ﺍﻟﻜﻔﺎﻟﺔ ﺍﻟﻌﺎﺌﻠﻴﺔ‪-‬ﺍﻟﻌﺠﺯ ﺍﻟﺼﺤﻲ ﻟﻸﺒﻨﺎﺀ‪...............................-‬‬

‫**********************‬

‫ﺇﻁﺎﺭ ﺨﺎﺹ ﺒﺎﻷﻜﺎﺩﻴﻤﻴﺔ‬ ‫ﺇﻁﺎﺭ ﺨﺎﺹ ﺒﺎﻟﻨﻴﺎﺒﺔ ﺍﻹﻗﻠﻴﻤﻴﺔ‬

‫ﺍﺴﻡ ﺍﻟﻤﻭﻅﻑ ﺍﻟﺫﻱ ﺭﺍﺠﻊ ﺍﻟﻤﻠﻑ‪:‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﻭﻅﻑ ﺍﻟﺫﻱ ﺭﺍﺠﻊ ﺍﻟﻤﻠﻑ‪:‬‬

‫ﺒﺘﺎﺭﻴﺦ‬ ‫ﺒﺘﺎﺭﻴﺦ‬

‫ﺍﻟﺘﻭﻗﻴﻊ‬ ‫ﺍﻟﺘﻭﻗﻴﻊ‬

‫‪ -1-‬ﻀﻊ ﺇﻁﺎﺭﺍ ﺤﻭل ﺍﻹﺠﺭﺍﺀ ﺍﻟﻤﻁﻠﻭﺏ‬