‫ﳕﻮﺫﺝ ﻃﻠﺐ ﻣﻨﺤﺔ ﺩﺭﺍﺳﻴﺔ‬

Scholarship Aplication Form

‫ﺍﻟﺼﻮﺭﺓ‬
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Personal Details: :
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ت ا‬
Name:_____________________ Nationality: __________ :
‫ _________________________ا‬:‫ا‬
Sex:
Male
Female - Place of Birth: __________ :‫!
ن اد‬ - ‫
ذآ
أ‬:‫ا‬

Date of Birth: \ \ Age: ____ :‫ا(ــــ‬ / / :‫" اد‬#‫

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Passport/ID Card: _______________________________
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Date & place of Issue: \ \ __________ / / :‫ار‬012‫" و!
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Date of Expiry: \ \ / / :‫
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Academic Details:(Past) :(
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ت ا‬

BA

Current Degree:

MA __________ 4?
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School/Univ: ______________________________________________________________:
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‫ر
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Country :______________________ City: __________ :
#0‫_____________________ ا‬:
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Specialty_______________________________________________________________________ :@4‫ا‬
Date of Graduatioon: \ \ / / :‫ج‬4C A,+4‫" ا‬#‫
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Gpa: ________________
Out of4
Out of5 ٥ E!
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Academic Details:(Present) :(

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ت ا‬
Current Degree:
MA
PhD ‫راة‬+4‫
دآ‬4?
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:
C=‫ا‬

School/Univ: ______________________________________________________________ :
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Country:______________________ City: __________ :
#0‫_____________________ ا‬:
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Specialty: ______________________________________________________________________ :@4‫ا‬
Study Start Date: \ \ / / :
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ا‬#‫ا‬07 "#‫
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AcademicYear: ___________ Study Language: __________ :
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ا‬J ____________:
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Semester : ___________ Study Duration: __________ :
‫را‬0‫ة ا‬0! ____________:K‫را‬0‫ ا‬9L‫ا‬
Postal Address: :‫ي‬0#‫ان ا‬+(‫ا‬
Country:______________________ City: __________ :
#0‫_____________________ ا‬:
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P.O.Box: __________ Postal Code: __________ :‫ي‬0#‫ ا‬Q!‫ا‬ __________ :‫ ب‬.‫ص‬

Address: _________________________________________________________________________ :‫ان‬+(‫ا‬

Mobile: ____________________________ ____________________________ :‫ال‬+‫ا‬

e-Mail Address: _________________________________________________________ :K‫و‬4 R‫ ا‬0#‫ا‬

Additional Information: :
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Tution Fees: ____________ Currency: _________ :
C(‫ا‬ _____________ :
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_______________:‫__________ ﺭﻗﻢ ﺍﳍﺎﺗﻒ‬:‫____________ ﺍﳌﺪﻳﻨﺔ‬:‫_____________________________ ﺍﻟﺪﻭﻟﺔ‬: ‫ﺇﺳﻢ ﺍﳉﻬﺔ‬
Do you receive scholarship or financial assissstence from any other body?
Yes
No
Name: _____________________________ Country: ___________ City: ____________ Tel: __________________


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أو ?(
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رآ‬#+\[ ‫] أي‬#0 9‫ه‬
_______________:‫__________ ﺭﻗﻢ ﺍﳍﺎﺗﻒ‬:‫____________ ﺍﳌﺪﻳﻨﺔ‬:‫_____________________________ ﺍﻟﺪﻭﻟﺔ‬: ‫ﺇﺳﻢ ﺍﳉﻬﺔ‬

Have you ever worked for or had membership in any Islamic organization?
Yes
No
Name: _____________________________ Country: ___________ City: ____________ Tel: __________________

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_______________:‫__________ ﺭﻗﻢ ﺍﳍﺎﺗﻒ‬:‫____________ ﺍﳌﺪﻳﻨﺔ‬:‫_____________________________ ﺍﻟﺪﻭﻟﺔ‬: ‫ﺇﺳﻢ ﺍﳉﻬﺔ‬

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ر‬4‫__________ ا‬: :A,+4‫_______________ ا‬: :b! _______________: ‫ﺃﺳﻢ ﺍﳌﺴﺆﻭﻝ‬
The supervising body:(Wamy office, member association, well-known personality,..)
Name: _____________________________ Country: ___________ City: ____________ Tel: __________________
Name: _________________________________ Signature: ______________________________

I DO hereby affirm that the information given ،
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رة د‬4‫ ا‬KS
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above is true to the best of my knowledge. .
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Name: _________________________________ _____________________________: :‫اـــ‬

Signature: ______________________________ _____________________________: :A,+4‫ا‬

‫‪Assistance Requirements‬‬ ‫^وط ا‪+H‬ل [‪ C‬ا
[‪0‬ة‬
‫‪ .١‬ﺃﻥ ﻳﻜﻮﻥ ﺍﳌﺘﻘﺪﻡ ﻣﻌﺮﻭﻓﹰﺎ ﺑﺎﻟﺘﺰﺍﻣﻪ ﺍﻹﺳﻼﻣﻲ ﻭﺑﺴﲑﺗﻪ ﺍﳊﺴﻨﺔ‪.‬‬
‫ﻼ ﻭﻣﻨﺘﻈﻤﹰﺎ ﰲ ﺇﺣﺪﻯ ﺍﳉﺎﻣﻌﺎﺕ ﺍﶈﺪﺩﺓ ﻣﻦ ﻗﺒﻞ ﺍﻟﻨﺪﻭﺓ‪.‬‬
‫‪ .٢‬ﺃﻥ ﻳﻜﻮﻥ ﻣﺴﺠ ﹰ‬
‫‪ .٣‬ﺃﻥ ﻻ ﻳﻘﻞ ﺍﳌﻌﺪﻝ ﺍﻟﺘﺮﺍﻛﻤﻲ ﻋﻦ ‪٣‬ﻣﻦ ‪ ٤‬ﺍﻭ ‪ ٩٠‬ﻣﻦ ‪ ١٠٠‬ﻛﺤﺪ ﺃﺩﱏ ﻋﻨﺪ ﲣﺮﺟﻪ ﻣﻦ ﺍﳌﺮﺣﻠﺔ ﺍﻟﺴﺎﺑﻘﺔ‪.‬‬
‫‪ .٤‬ﺃﻥ ﻳﻜﻮﻥ ﺍﻟﺘﺨﺼﺺ ﰲ ﳎﺎﻝ ﺍﻟﺘﺨﺼﺼﺎﺕ ﺍﻟﱵ ﻳﺪﻋﻤﻬﺎ ﻭﻳﺸﺠﻌﻬﺎ ﺑﺮﻧﺎﻣﺞ ﺍﳌﻨﺢ ﺑﺎﻟﻨﺪﻭﺓ‪.‬‬
‫‪ .٥‬ﺃﻥ ﻳﻜﻮﻥ ﺍﻟﻄﺎﻟﺐ ﲝﺎﺟﺔ ﺇﱃ ﻣﺴﺎﻋﺪﺓ ﻣﺎﻟﻴﺔ ﻭﻟﻮﻻﻫﺎ ﻟﺘﻮﻗﻒ ﻋﻦ ﺍﻟﺪﺭﺍﺳﺔ‪.‬‬
‫‪ .٦‬ﺃﻥ ﳛﻀﺮ ﺗﺰﻛﻴﺘﲔ ﻣﻦ ﻣﻨﻈﻤﺎﺕ ﺃﻭ ﺷﺨﺼﻴﺎﺕ ﺇﺳﻼﻣﻴﺔ ﻣﻌﺮﻭﻓﺔ ﻟﺪﻯ ﺍﻟﻨﺪﻭﺓ ﺍﻟﻌﺎﳌﻴﺔ ﻟﻠﺸﺒﺎﺏ ﺍﻹﺳﻼﻣﻲ‪.‬‬

‫ا‪ ef
g+‬ا`‪:
7+C‬‬
‫‪ .١‬ﺻﻮﺭﺓ ﻣﻦ ﺁﺧﺮ ﻣﺆﻫﻞ‬
‫‪ .٢‬ﺻﻮﺭﺓ ﻣﻦ ﺍﻟﺴﺠﻞ ﺍﻷﻛﺎﺩﳝﻲ ﻟﻠﻤﺮﺣﻠﺔ ﺍﻟﺪﺭﺍﺳﻴﺔ ﺍﻟﺴﺎﺑﻘﺔ‪.‬‬
‫‪ .٣‬ﺻﻮﺭﺓ ﻣﻦ ﻗﻴﺪ ﺍﻻﻧﺘﻈﺎﻡ ﰲ ﺍﻟﺪﺭﺍﺳﺔ‬
‫‪ .٤‬ﺻﻮﺭﺓ ﻣﻦ ﺍﳍﻮﻳﺔ ﺃﻭ ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ‬
‫‪ .٥‬ﻛﺸﻒ ﺣﺴﺎﺏ ﺑﻨﻜﻲ ﺣﺪﻳﺚ ﻵﺧﺮ ﺛﻼﺙ ﺷﻬﻮﺭ‪.‬‬
‫‪. .٦‬ﺻﻮﺭﺗﺎﻥ ﴰﺴﻴﺔ ﺣﺪﻳﺜﺔ ﻣﻠﻮﻧﺔ‬
‫‪ .٧‬ﺳﲑﺓ ﺫﺍﺗﻴﺔ ﻟﻠﻄﺎﻟﺐ ﻭﳕﺎﺫﺝ ﻣﻦ ﺃﻋﻤﺎﻟﻪ ﺍﻟﻔﻜﺮﻳﺔ ﺃﻭ ﺍﻷﺩﺑﻴﺔ‪.‬‬
‫!(‪
!+C‬ت !‪:
.‬‬
‫‪ .١‬ﺍﻷﻭﻟﻮﻳﺔ ﰲ ﺍﳌﻨﺢ ﻟﻠﻤﻘﻴﺪﻳﻦ ﺍﳉﺪﺩ ﰲ ﺍﳉﺎﻣﻌﺎﺕ‪.‬‬
‫‪ .٢‬ﻣﺪﺓ ﺍﳌﻨﺤﺔ ﻣﻦ ﺳﻨﺘﲔ ﺇﱃ ﺛﻼﺙ ﺳﻨﻮﺍﺕ ﻟﻠﻤﺮﺣﺔ ﺍﻟﺪﺭﺍﺳﻴﺔ ﺍﻟﻮﺍﺣﺪﺓ ﲝﺴﺐ ﻧﻈﺎﻡ ﺍﻟﺪﺭﺍﺳﺔ ﰲ ﺍﻟﻜﻠﻴﺔ ﺍﳌﻘﻴﺪ ‪‬ﺎ ﺍﻟﻄﺎﻟﺐ‪.‬‬
‫‪ .٣‬ﻧﻈﺎﻡ ﺍﻟﺪﺭﺍﺳﺔ ﺍﳌﻌﺘﻤﺪ ﻫﻮ ﻧﻈﺎﻡ "ﺍﻻﻧﺘﻈﺎﻡ" ﻓﻘﻂ‪.‬‬
‫ﳌﺰﻳﺪ ﻣﻦ ﺍﳌﻌﻠﻮﻣﺎﺕ ﺍﻻﺗﺼﺎﻝ ﻋﻠﻰ ﺇﺩﺍﺭﺓ ﺍﻟﺸﺆﻭﻥ ﺍﻟﺘﻌﻠﻴﻤﻴﺔ ﺑﺎﻟﻨﺪﻭﺓ ﺍﻟﻌﺎﳌﻴﺔ ﻟﻠﺸﺒﻠﺐ ﺍﻹﺳﻼﻣﻲ ‪:‬‬
‫ﻓﺎﻛﺲ )‪(+٩٩٦ ١ ٢٠٥٣٨٧٤‬‬ ‫ﻫﺎﺗﻒ )‪ (+٩٩٦ ١ ٢٠٥٠٠٠٠‬ﲢﻮﻳﻠﺔ )‪ ٣٥٥‬ـ ‪(٣٥٧‬‬
‫ﺹ ﺏ ‪ ١٠٨٤٥‬ﺍﻟﺮﻳﺎﺽ ‪edu-riyadh@wamy.org -١١٤٤٣‬‬