‫ﻓﺮﻡ ﺗﻌﻴﻴﻦ ﺍﺳﺘﺎﺩ ﺭﺍﻫﻨﻤﺎﻱ ﭘﺎﻳﺎﻥﻧﺎﻣﻪ ﻛﺎﺭﺷﻨﺎﺳﻲ ﺍﺭﺷﺪ‬

‫ﺩﺍﻧﺸﺠﻮﻱ ﻣﺤﺘﺮﻡ‪ :‬ﻟﻄﻔﺎ ﭘﺲ ﺍﺯ ﻣﻮﺍﻓﻘﺖ ﻭ ﺗﺎﻳﻴﺪ ﺍﺳﺘﺎﺩ‪/‬ﺍﺳﺎﺗﻴﺪ ﺭﺍﻫﻨﻤﺎﻱ ﭘﻴﺸﻨﻬﺎﺩﻱ‪ ،‬ﻓﺮﻡ ﺭﺍ ﺑﻪ ﺩﻓﺘﺮ ﺗﺤﺼﻴﻼﺕ ﺗﻜﻤﻴﻠﻲ ﺩﺍﻧﺸﻜﺪﻩ ﺗﺤﻮﻳﻞ ﺩﻫﻴﺪ‪ .‬ﺣﺘﻲ ﺩﺭ ﺻﻮﺭﺗﻲ ﻛﻪ‬

‫ﺑﻪﻃﻮﺭ ﻗﻄﻌﻲ ﻧﭙﺬﻳﺮﻓﺘﻨﺪ ﭘﺸﺖ ﺍﻳﻦ ﻓﺮﻡ ﺭﺍ ﺗﻜﻤﻴﻞ ﻧﻤﺎﻳﻴﺪ ﻭ ﺗﺎ ﻣﻬﻠﺖ ﻣﺬﻛﻮﺭ ﺗﺤﻮﻳﻞ ﺩﻫﻴﺪ‪.‬‬
‫ﻫﻴﭻ ﻳﻚ ﺍﺯ ﺍﺳﺎﺗﻴﺪ ﺭﺍﻫﻨﻤﺎﻳﻲ ﺷﻤﺎ ﺭﺍ ‌‬

‫ﺑﻪ ‪ :‬ﺷﻮﺭﺍﻱ ﺗﺤﺼﻴﻼﺕ ﺗﻜﻤﻴﻠﻲ ﺩﺍﻧﺸﻜﺪﻩ ﺑﺮﻕ ﻭ ﻛﺎﻣﭙﻴﻮﺗﺮ‬

‫ﺍﻳﻨﺠﺎﻧﺐ ‪....................................‬ﺑﻪ ﺷﻤﺎﺭﻩ ﺩﺍﻧﺸﺠﻮﻳﻲ ‪ ..............................‬ﺩﺍﻧﺸﺠﻮﻱ ﻛﺎﺭﺷﻨﺎﺳﻲ ﺍﺭﺷﺪ ﺭﺷﺘﻪ ‪..........................................‬‬
‫ﺑﺪﻳﻦ ﻭﺳﻴﻠﻪ ﺍﻋﻼﻡ ﻣﻲﺩﺍﺭﻡ ﻛﻪ ﺍﺳﺘﺎﺩ‪/‬ﺍﺳﺎﺗﻴﺪ ﺭﺍﻫﻨﻤﺎﻱ )ﺗﺤﻘﻴﻖ ﭘﺎﻳﺎﻥﻧﺎﻣﻪ ﻛﺎﺭﺷﻨﺎﺳﻲ ﺍﺭﺷﺪ( ﭘﻴﺸﻨﻬﺎﺩﻱ ﺍﻳﻨﺠﺎﻧﺐ ﺟﻨﺎﺏ ﺁﻗﺎﻱ‪/‬ﺳﺮﻛﺎﺭ‬
‫ﺧﺎﻧﻢ ﺩﻛﺘﺮ ‪ .......................................................................‬ﻫﺴﺘﻨﺪ ﻛﻪ ﻣﻮﺍﻓﻘﺖ ﺧﻮﺩ ﺭﺍ ﺍﺑﺮﺍﺯ ﻧﻤﻮﺩﻩﺍﻧﺪ‪.‬‬
‫ﺧﻮﺍﻫﺸﻤﻨﺪﻡ ﻧﻈﺮ ﻗﻄﻌﻲ ﺷﻮﺭﺍﻱ ﺗﺤﺼﻴﻼﺕ ﺗﻜﻤﻴﻠﻲ ﺩﺍﻧﺸﻜﺪﻩ ﺭﺍ ﺑﻪ ﺍﻳﻨﺠﺎﻧﺐ ﺍﺑﻼﻍ ﻓﺮﻣﺎﻳﻴﺪ‪.‬‬

‫ﺗﺎﺭﻳﺦ‪:‬‬ ‫ﺍﻣﻀﺎءﺩﺍﻧﺸﺠﻮ‪:‬‬

‫ﻧﻈﺮ ﺍﺳﺘﺎﺩ‪/‬ﺍﺳﺎﺗﻴﺪ ﺭﺍﻫﻨﻤﺎﻱ ﭘﻴﺸﻨﻬﺎﺩﻱ‪:‬‬

‫ﺩﺭﺻﺪ ﻣﺸﺎﺭﻛﺖ( ﺍﻋﻼﻡ‬ ‫ﺁﻣﺎﺩﮔﻲ ﺧﻮﺩ ﺭﺍﺑﺮﺍﻱ ﺭﺍﻫﻨﻤﺎﺋﻲ ﺗﺤﻘﻴﻖ ﭘﺎﻳﺎﻥﻧﺎﻣﻪ ﻛﺎﺭﺷﻨﺎﺳﻲ ﺍﺭﺷﺪ )ﺑﺎ‬ ‫ﺍﻳﻨﺠﺎﻧﺐ‬
‫ﻣﻲﺩﺍﺭﻡ‪.‬ﺩﺭﺿﻤﻦ ﺭﺷﺘﻪ ﻭ ﺗﻌﺪﺍﺩ ﺩﺍﻧﺸﺠﻮﻳﺎﻧﻲ ﻛﻪ ﺭﺍﻫﻨﻤﺎﻳﻲ ﺁﻧﻬﺎ ﺭﺍ ﭘﺬﻳﺮﻓﺘﻪ ﺍﻡ ﺑﺎ ﻇﺮﻓﻴﺖ ﺍﻋﻼﻡ ﺷﺪﻩ ﺗﻄﺎﺑﻖ ﺩﺍﺭﺩ ‪.‬‬

‫ﺗﺎﺭﻳﺦ‪:‬‬ ‫ﺍﻣﻀﺎء ﺍﺳﺘﺎﺩﺭﺍﻫﻨﻤﺎﻱ ﺍﻭﻝ‪:‬‬

‫ﺩﺭﺻﺪ ﻣﺸﺎﺭﻛﺖ( ﺍﻋﻼﻡ‬ ‫ﺁﻣﺎﺩﮔﻲ ﺧﻮﺩ ﺭﺍﺑﺮﺍﻱ ﺭﺍﻫﻨﻤﺎﺋﻲ ﺗﺤﻘﻴﻖ ﭘﺎﻳﺎﻥﻧﺎﻣﻪ ﻛﺎﺭﺷﻨﺎﺳﻲ ﺍﺭﺷﺪ)ﺑﺎ‬ ‫ﺍﻳﻨﺠﺎﻧﺐ‬
‫ﻣﻲﺩﺍﺭﻡ‪ .‬ﺩﺭﺿﻤﻦ ﺭﺷﺘﻪ ﻭ ﺗﻌﺪﺍﺩ ﺩﺍﻧﺸﺠﻮﻳﺎﻧﻲ ﻛﻪ ﺭﺍﻫﻨﻤﺎﻳﻲ ﺁﻧﻬﺎ ﺭﺍ ﭘﺬﻳﺮﻓﺘﻪ ﺍﻡ ﺑﺎ ﻇﺮﻓﻴﺖ ﺍﻋﻼﻡ ﺷﺪﻩ ﺗﻄﺎﺑﻖ ﺩﺍﺭﺩ ‪.‬‬

‫ﺗﺎﺭﻳﺦ‪:‬‬ ‫ﺍﻣﻀﺎء ﺍﺳﺘﺎﺩﺭﺍﻫﻨﻤﺎﻱ ﺩﻭﻡ‪:‬‬

‫ﺍﻇﻬﺎﺭ ﻧﻈﺮ ﮔﺮﻭﻩ‪:‬ﺑﻼﻣﺎﻧﻊ ﺍﺳﺖ‪ ‬ﺑﻪ ﺩﻟﻴﻞ ﺯﻳﺮ ﮔﺮﻭﻩ ﻣﻮﺍﻓﻘﺖ ﻧﺪﺍﺭﺩ ‪‬‬

‫ﺗﺎﺭﻳﺦ‪:‬‬ ‫ﺍﻣﻀﺎء ﻣﺪﻳﺮ ﮔﺮﻭﻩ‪:‬‬

‫ﻧﻈﺮ ﺷﻮﺭﺍﻱ ﺗﺤﺼﻴﻼﺕ ﺗﻜﻤﻴﻠﻲ ﺩﺍﻧﺸﻜﺪﻩ‪:‬‬ ‫‪0B‬‬

‫ﺿﻮﺍﺑﻂ ﻣﺮﺑﻮﻁ ﺑﻪ ﺗﻌﺪﺍﺩ ﭘﺎﻳﺎﻥﻧﺎﻣﻪﻫﺎﻱ ﻛﺎﺭﺷﻨﺎﺳﻲ ﺍﺭﺷﺪ ﺗﺤﺖ ﺭﺍﻫﻨﻤﺎﻳﻲ ﺍﺳﺘﺎﺩ‪/‬ﺍﺳﺎﺗﻴﺪ ﺭﺍﻫﻨﻤﺎ ﻭ ﻇﺮﻓﻴﺖ ﺍﻋﻼﻡ ﺷﺪﻩ ﺍﻳﺸﺎﻥ‬
‫ﻣﺮﺍﻋﺎﺕ ﺷﺪﻩ ﺍﺳﺖ‪‬ﻧﺸﺪﻩ ﺍﺳﺖ‪.‬‬
‫ﺍﺯ ﻧﻈﺮ ﺷﻮﺭﺍﻱ ﺗﺤﺼﻴﻼﺕ ﺗﻜﻤﻴﻠﻲ ﺩﺍﻧﺸﻜﺪﻩ ﺑﺮﻕ ﻭ ﻛﺎﻣﭙﻴﻮﺗﺮ‪ ،‬ﭘﻴﺸﻨﻬﺎﺩ ﺩﺍﻧﺸﺠﻮ ﻣﻮﺭﺩ ﺗﺄﻳﻴﺪ ﻣﻲﺑﺎﺷﺪ ‪‬ﻧﻤﻲﺑﺎﺷﺪ‪.‬‬

‫ﺍﻣﻀﺎء ﺳﺮﭘﺮﺳﺖ ﺗﺤﺼﻴﻼﺕ ﺗﻜﻤﻴﻠﻲ‪ :‬ﺗﺎﺭﻳﺦ‪:‬‬

 ‫ﺷﻤﺎﺭﻩ ﺩﺍﻧﺸﺠﻮﻳﻲ‪:‬‬ ‫ﻧﺎﻡ ﻭ ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ ‪:‬‬ ‫ﻣﺸﺨﺼﺎﺕ ﺩﺍﻧﺸﺠﻮ ‪:‬‬
‫‪ ‬ﻧﻮﺑﺖ ﺩﻭﻡ‬ ‫ﺩﻭﺭﻩ‪ :‬ﺭﻭﺯﺍﻧﻪ‬ ‫ﺭﺷﺘﻪ‪:‬ﻣﻬﻨﺪﺳﻲ‬

‫ﺯﻣﻴﻨﻪ ﻫﺎﻱ ﻣﻮﺭﺩ ﻋﻼﻗﻪ ﺑﺮﺍﻱ ﺗﺤﻘﻴﻖ ﭘﺎﻳﺎﻥ ﻧﺎﻣﻪ ﺑﻪ ﺗﺮﺗﻴﺐ ﺍﻭﻟﻮﻳﺖ‬
‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬

‫‪6‬‬ ‫‪5‬‬ ‫‪4‬‬

‫ﮔﺰﺍﺭﺵ ﻣﺮﺍﺟﻌﻪ ﺑﻪ ﺍﺳﺎﺗﻴﺪ‬

‫ﺗﻮﺿﻴﺤﺎﺕ )ﺩﺭ ﺻﻮﺭﺕ ﻟﺰﻭﻡ(‬ ‫ﺩﻟﻴﻞ ﻋﺪﻡ ﻣﻮﺍﻓﻘﺖ ﺍﺳﺘﺎﺩ‬ ‫ﻧﺎﻡ ﺍﺳﺘﺎﺩ‬
‫ﺗﻜﻤﻴﻞ ﻇﺮﻓﻴﺖ ‪‬‬ ‫ﻋﺪﻡ ﺍﻋﻼﻡ ﻇﺮﻓﻴﺖ ﺩﺭ ﮔﺮﺍﻳﺶ‪‬‬
‫‪1‬‬
‫ﺳﺎﻳﺮ ﻣﻮﺍﺭﺩ‪‬‬ ‫ﻋﺪﻡ ﺗﻄﺒﻴﻖ ﺯﻣﻴﻨﻪ ﻫﺎﻱ ﻣﻮﺭﺩ ﻋﻼﻗﻪ‪‬‬
‫ﺗﻜﻤﻴﻞ ﻇﺮﻓﻴﺖ ‪‬‬ ‫ﻋﺪﻡ ﺍﻋﻼﻡ ﻇﺮﻓﻴﺖ ﺩﺭ ﮔﺮﺍﻳﺶ‪‬‬
‫‪2‬‬
‫ﺳﺎﻳﺮ ﻣﻮﺍﺭﺩ‪‬‬ ‫ﻋﺪﻡ ﺗﻄﺒﻴﻖ ﺯﻣﻴﻨﻪ ﻫﺎﻱ ﻣﻮﺭﺩ ﻋﻼﻗﻪ‪‬‬
‫ﺗﻜﻤﻴﻞ ﻇﺮﻓﻴﺖ ‪‬‬ ‫ﻋﺪﻡ ﺍﻋﻼﻡ ﻇﺮﻓﻴﺖ ﺩﺭ ﮔﺮﺍﻳﺶ‪‬‬
‫‪3‬‬
‫ﺳﺎﻳﺮ ﻣﻮﺍﺭﺩ‪‬‬ ‫ﻋﺪﻡ ﺗﻄﺒﻴﻖ ﺯﻣﻴﻨﻪ ﻫﺎﻱ ﻣﻮﺭﺩ ﻋﻼﻗﻪ‪‬‬
‫ﺗﻜﻤﻴﻞ ﻇﺮﻓﻴﺖ ‪‬‬ ‫ﻋﺪﻡ ﺍﻋﻼﻡ ﻇﺮﻓﻴﺖ ﺩﺭ ﮔﺮﺍﻳﺶ‪‬‬
‫‪4‬‬
‫ﺳﺎﻳﺮ ﻣﻮﺍﺭﺩ‪‬‬ ‫ﻋﺪﻡ ﺗﻄﺒﻴﻖ ﺯﻣﻴﻨﻪ ﻫﺎﻱ ﻣﻮﺭﺩ ﻋﻼﻗﻪ‪‬‬
‫ﺗﻜﻤﻴﻞ ﻇﺮﻓﻴﺖ ‪‬‬ ‫ﻋﺪﻡ ﺍﻋﻼﻡ ﻇﺮﻓﻴﺖ ﺩﺭ ﮔﺮﺍﻳﺶ‪‬‬
‫‪5‬‬
‫ﺳﺎﻳﺮ ﻣﻮﺍﺭﺩ‪‬‬ ‫ﻋﺪﻡ ﺗﻄﺒﻴﻖ ﺯﻣﻴﻨﻪ ﻫﺎﻱ ﻣﻮﺭﺩ ﻋﻼﻗﻪ‪‬‬

‫ﻟﻴﺴﺖ ﺍﺳﺎﺗﻴﺪ ﺭﺍﻫﻨﻤﺎﻱ ﻣﻮﺭﺩ ﻋﻼﻗﻪ ﺩﺍﻧﺸﺠﻮ ﺑﻪ ﺗﺮﺗﻴﺐ ﺍﻭﻟﻮﻳﺖ‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬

‫‪8‬‬ ‫‪7‬‬ ‫‪6‬‬ ‫‪5‬‬

‫‪12‬‬ ‫‪11‬‬ ‫‪10‬‬ ‫‪9‬‬

‫ﺗﻮﺿﻴﺤﺎﺕ ﺩﻳﮕﺮ )ﺩﺭ ﺻﻮﺭﺕ ﻟﺰﻭﻡ(‪:‬‬

‫ﺗﺎﺭﻳﺦ‪:‬‬ ‫ﺍﻣﻀﺎءﺩﺍﻧﺸﺠﻮ‪:‬‬