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Exam Request Form

All fields marked with * are required.

* Surname
 * First or Given Names
 Student Number

* Email
 Phone Number

Mailing Address
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*Current Course Code
 *Course Type

*Preferred Location
 *Preferred Exam Date (dd/mm/yyyy)
//		 Exam Type

*Do you have any special requirements:
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If An off-campus exam is necessary: Please fill in Proctor's information below:

Note: You are responsible for all fees associated with off-campus exams.

University or College (Name)

Procter Surname
 First or Given Names
 Phone Number

Title
 Email

Mailing Address
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 Province
 Postal/Zip Code

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