Fillable Examination Request Form (Athabasca University)

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Examination Request Form (Athabasca University)

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r I acknowledge that my invigilator is open and I have booked my exam.
Examination Request Form
This form is for writing exams with an already approved AU invigilator. If you would like to
request a new invigilator, use the Invigilator Request Form. Before completing this form,
consult your tutor, your exam invigilator, and review the Exams section of the AU Calendar,
www.athabascau.ca/calendar/undergraduate/exams-grades/requesting-an-exam.html
STUDENT ID NUMBER
General
Information
(please print)
Exams:
Office of the Registrar, Athabasca Univ
ersity
1 University Drive, Athabasca, AB
T9S 3A3
examunit@athabascau.ca
Toll Free in Canada/US: 1.800.788.9041
Other: 780.675.6111
www.athabascau.ca
Exams, Accessibility Services
asdexam@athabascau.ca
Student Name: _____________________________________________________________
LAST
FIRST MIDDLE
_____________________________________________________________
MAILING ADDRESS
_____________________________________________________________
CITY/TOWN PROVINCE/STATE
_____________________________________________________________
COUNTRY POSTAL/ZIP CODE
(______)______________________(_______)________________________
PRIMARY PHONE SECONDARY PHONE
EMAIL
r Midterm r Second Midterm (BIOL 230 & 235 only)
r Final r Challenge for Credit
attempt at writing this examination
nd attempt at writing this examination and I am enclosing the supplemental exam fee*.
iple exam request and I am enclosing the multiple exam fee*.
* See page two for additional details.
r I have confirmed the following write date with the invigilator/invigilation centre:
DAY MONTH YEAR
______________________________________________________________
Pg 1 of 2
The personal information collected on this form will be used to process your request and for the purpose of processing payments. This personal information is being collected under the authority of Sec-
tion 33(c) of Alberta's Freedom of Information and Protection of Privacy Act. If you have any questions about the collection and use of this information for processing your request, contact the Coordinator,
Enrolment Services. If you have questions about the collec tion and use of this information for processing payment, contact the Senior Accountant, Athabasca University, 1 University Drive, Athabasca,
Alberta,
T9S 3A3, Phone: 800.788.9041.
If paying by e-transfer or credit card, first submit this completed form to examunit@athabascau.ca, then follow the instructions below. Your request will not
be processed until payment is received by Athabasca University.
r
___
C
redit cards will not be accepted by email. Do not send confidential information via email. Email messages
order or cheque, but there is currently a time delay with these options. Please do not send cash in the mail.
If you require assistance or have further questions about payment, please call 1-800-788-9041
Refer to a current Calendar for fee information, athabascau.ca/calendar/undergraduate/fees-refunds-and-financial-assistance/index.html
_____________________________________________________________
Course Name/Number: __________________________________________ Course End Date: __________________
Examination:
This is my:
r first
r seco
r mult
Examination Centre/
Invigilator Inform
ation
I would like to write my exam at the following invigilator:
Invigilator ID:
Invigilator/Institution Name: ______________________________________________________________
LIST FEES TO PAY
FEES SUBMITTED
Payment
e-transfer*: include the following information here:
_____________________________________________________________________
NAME ON E-TRANSFER ACCOUNT DATE OF TRANSFER
* If paying by e-transfer,
transfer to: finar@athabascau.ca Please include the following in the message box of your bank transfer (if applicable): student ID
number, your full name, the type of fee paying, course name/number, your email address and phone number.
r Credit card (Visa or MasterCard):
are not secure.
r Other: You can also pay by mailing a money
Post-dated cheques are not accepted.
Review fees: www.athabascau.ca/calendar/undergraduate/fees-refunds-and-financial-assistance/
academic-related-fees.html
Writing Exams: Before you submit your Examination Request Form, contact the appropriate centre (or your invigilator)
where you wish to write, and reserve a date and time. Request your exam a minimum of 20 days with an
established AU-approved invigilator from the date Examination Services receives the request for receipt
of your examination. Allow a minimum of 60 days with a proposed invigilator from the date Examination
Services receives the request for receipt of your examination. You do not require permission to write an
exam, but you should discuss your preparedness with your tutor or learning facilitator.
Approved invigilation centre: Students who live within 100 km of an Exam Invigilation Network centre are required to write at a centre.
Students are not required to use the centre closest to them. Students who live more than 100 km from
an exam centre may write their exam closer to home provided they arrange for a suitable invigilator who
meets the invigilator guidelines, and who is willing to invigilate their exam. All students who live outside
Canada must write their exams at an approved post-secondary institution or a participating Canadian
Embassy. If you would like to request an invigilator that is not currently one of AU’s approved invigilators,
you must request one using the Invigilator Request Form.
• Exam Information: www.athabascau.ca/support-services/exam-services-support/index.html
• Exam Invigilation Network: www.athabascau.ca/support-services/exam-services-support/finding-
exam-locations/index.html
Unwritten Exams: Occasionally, circumstances will prevent a student from writing the exam on the scheduled write date.
If this happens to you, you can reschedule the exam write date. Rescheduling must take place within
ten business days after the originally requested write date. Invigilators are required to return unwritten
exams within ten business days after the requested write date. Students who wish to reschedule their
exam write date must submit a new Examination Request Form and the multiple exam fee.
• Multiple exam fees: www.athabascau.ca/calendar/undergraduate/fees-refunds-and-financial-
assistance/academic-related-fees.html
Supplemental Exams: Students who are not satisfied with their initial examination mark, may write one supplemental
examination for each examination written. This option does not apply to challenge courses. The
supplemental examination must be written within 30 days of the examination request. If you choose to
request and write a supplemental examination, your request must be received no later than 90 calendar
days after writing the original examination. The supplemental exam fee is non-refundable. Your final mark
will be the higher of the two marks received.
• Supplemental exam fees: www.athabascau.ca/calendar/undergraduate/fees-refunds-and-financial-
assistance/academic-related-fees.html
• Supplemental exam information: www.athabascau.ca/calendar/undergraduate/exams-grades/
supplemental-exams.html
Late Exam Request: This is a request for an exam that has been received after the exam request deadline, but before the
student’s contract end date. In such cases, the Late Exam Request fee will be applied. The Late Exam
Request fee does not cover courier fees or establish a timeline for the delivery of your exam.
Important
Information
Pg 2 of 2
Apr. 2022
COVID-19 preventative measures will be in place at third-party AU approved invigilators or invigilation
centres, such as another university or a public library, to reduce the spread of COVID-19. However, AU
cannot guarantee that students will not be exposed to COVID-19 and cannot guarantee that students
will not contract COVID-19 due to attendance at a third-party AU approved invigilator or invigilation
centre. Students acknowledge that they are aware of and understand the contagious nature of COVID-
19 and freely and voluntarily accept and fully assume all responsibility for all risks, and all possibilities of
personal injury, illness, death or loss to themselves or any other person as a result of attendance at an
invigilator or invigilation centre. Students assume and accept all COVID-19 related risks arising out of the
student’s attendance and/or participation at the third-party AU approved invigilator or invigilation centre.
Students who choose to write exams with a third-party AU approved invigilator or invigilation centre are
responsible for ensuring that that they are comfortable with COVID-19 precautions in place at that site
and that they will abide by them. Any specific requirements should be confirmed with invigilation sites
directly.
r I acknowledge that I have read, understand, and will abide by the COVID-19 information
presented above.
Exams Booked at
External Invigilators
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Completed 11 May 2022

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