Application for Student-Arranged Site and Proctoring
Step One.
Please fill in the following information :
Student One
Name :
User Id :
Email :
Exam :
Student Two
Name :
User Id :
Email :
Exam :
Student Three
Name :
User Id :
Email :
Exam :
Student Four
Name :
User Id :
Email :
Exam :
Student Five
Name :
User Id :
Email :
Exam :
Student Six
Name :
User Id :
Email :
Exam :
Student Seven
Name :
User Id :
Email :
Exam :
Student Eight
Name :
User Id :
Email :
Exam :
Student Nine
Name :
User Id :
Email :
Exam :
Student Ten
Name :
User Id :
Email :
Exam :
Step Two
Please fill in a date
Time : AM PM
Please Note :
If you are requesting different date or time a special request must be submitted by email to exam@cusource.ca for regular CUIC exams or taylors@cusource.ca for cohort exam.
Step three
Please fill in all the details about your proctor:
Please Note :
Please include the phone and fax numbers for your proctor as well as his/her complete street address. The exam package will be couriered to your proctor, therefore, a post office box number address cannot be used.
Name :
Title :
Work Number:
Fax Number:
E-mail :
Step Four
Please fill the details about your exam location :
Exam Site Name :
Street Address :
City :
Province :
Postal Code :
Step Five
Please tell us where to send the exam :
Name :
Street Address :
City :
Province :
Postal Code :
Notes :