Fillable DEFERRED EXAMINATION REQUEST FORM (MacEwan University)

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DEFERRED EXAMINATION REQUEST FORM (MacEwan University)

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Country of origin: CANADA
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OFFICE OF THE UNIVERSITY REGISTRAR
Mailing Address: P.O. Box 1796 • Edmonton, Alberta, Canada T5J 2P2
Phone: 780-497-5000 • Toll Free: 1-888-497-4622
Website: www.MacEwan.ca • E-mail: info@macewan.ca
FREEDOM OF INFORMATION & PROTECTION OF PRIVACY
Protection of Privacy - The personal information requested on this form is collected and protected under the authority of Part 2 of the Alberta Freedom of Information and Protection of
Privacy Act and the Post-Secondary Learning Act. It will be used for the enrollment process and student management consistent with that purpose. This information will be entered into and
retained in the ofcial university student information system database. Direct questions expressly related to the collection and use of this information to the Associate Registrar, Records,
Ofce of the University Registrar, MacEwan University, 10700-104 Avenue, Edmonton, AB, T5J 4S2, telephone 780-633-3110.
DEFERRED EXAMINATION REQUEST FORM
PLEASE READ INSTRUCTIONS ON SECOND PAGE BEFORE SUBMITTING THIS FORM
PART A
PART B
TO BE COMPLETED BY THE STUDENT
TO BE COMPLETED BY THE CHAIR (OR DESIGNATE)
STUDENT ID NO.:
FAMILY (LAST) NAME: FIRST NAME: MIDDLE NAME:
FORMER NAME(S) (IF APPLICABLE) ADDRESS: CITY/PROVINCE: POSTAL CODE:
HOME PH.: CELL: WORK PH.: EXT.
PROGRAM:
I HAVE READ THE REGULATIONS AND INSTRUCTIONS ON THE REVERSE OF THIS FORM:
COURSE NO. ______________________________ SECTION ______________________________________ COURSE NAME ________________________________
TERM _____________________________________ INSTRUCTOR ________________________________
DATE _____________________________________ STUDENT’S SIGNATURE __________________________________________________________________________
REASON FOR BEING UNABLE TO ATTEND SCHEDULED EXAM:
______________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________
DEFERRED EXAM GRANTED. (FEES WILL BE APPLIED TO YOUR STUDENT ACCOUNT).
EXAM MUST BE WRITTEN BETWEEN: (DATE) _________________________________ AND (DATE) __________________________________________
CHAIR (OR DESIGNATE) SIGNATURE ____________________________________________________ DATE: ______________________
EXAM ATTACHED OR PASS CODE ATTACHED
EXAM SERVICES WILL CONTACT STUDENT TO SCHEDULE EXAM APPOINTMENT.
FEE
DEFERRED EXAM - ($75/EXAM TO A MAXIMUM OF $150 PER SCHEDULED EXAM PERIOD) TO BE ADDED TO THE STUDENT’S ACCOUNT AT THE TIME THE
REQUEST IS APPROVED.
EXAM SERVICES
Mailing Address: P.O. Box 1796 • Edmonton, Alberta, Canada T5J 2P2
Phone: 780-497-4780 • Toll Free: 1-888-497-4622
Website: www.MacEwan.ca/ExamServicesCentre
E-mail: exambooking@macewan.ca
PERSONAL INFORMATION COLLECTION NOTICE
The personal information requested on this form is collected under Section.33(c) of the Freedom of Information and Protection of Privacy Act for the purpose of one or all
of the following: to determine eligibility for admission and financial assistance, to advise students about academic programs and to provide university services at MacEwan
University. Questions concerning this collection should be directed to the Lead, Privacy and Information Management at privacy@macewan.ca
DEFERRED EXAMINATION REQUEST
INSTRUCTIONS: FOR COMPLETION OF THE DEFERRED EXAMINATION REQUEST FORM
1. A Student who is unable to write a final examination at the scheduled time for a compelling reason (such as illness, domestic affliction, or
religious conviction) must apply to his or her instructor for a deferred examination no later than two (2) days after the missed final
examination.
2. The student completes Part A.
3. The student takes the form and supporting documentation to the Chair or designate to complete Part B.
4. If a deferred exam is approved, the Chair or designate shall schedule the exam with Exam Services using the Deferred Examination
Request Form.
5. The approved Deferred Examination Request form, along with the examination, is forwarded to Exam Services Centre (6-224).
6. A grade of “DEF” (deferred) will be entered for the course on the studentʼs record by the instructor.
7. Exam Services will contact the student to book an appointment in the Exam Room and applies the deferred exam fee to the student
account upon beginning the deferred exam.
8. Once the deferred examination is completed, Exam Services will notify the instructor and arrange a pick-up if the exam is paper-
based.
9. The Chair shall advise the Office of the University Registrar of the final grade assigned through a grade change form.
10. The Office of the University Registrar will issue the results to the student.
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DEFERRED EXAMINATION REQUEST FORM (MacEwan University)

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Completed 30 January 2021

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