Test # 1 Test # 2 Test #3
Invigilation Request Form
12-2018
It is your responsibility to ensure that all sections of this form are
completed and submitted to the Centre for Flexible Learning (cFLEX):
■ Courses less than four (4) weeks in duration:
No later than five (5) days after the course starts.
■ Courses more than four (4) weeks in duration:
No later than three (3) weeks prior to the exam date.
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Midterm Exam Final Exam
1. Complete this form online, save and/or print.
2. To submit completed forms:
■ Email to dl.exam@senecacollege.ca; or
■ Fax to 416-756-4360
For assistance email dl.exam@senecacollege.ca or
call 416-491-5050 ext. 24141.
➤NOTE: This form is for Seneca Students Only
Number & Street Unit #/Apt City Province Postal Code
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Select the assessment format:
Online format
Paper-based format
* If you are unsure, please contact
your instructor prior to submitting
this form.
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Please be advised that any invigilation form that is not received on or before the specified dates will not be processed and you
will have to write at one of Seneca’s test centres during your originally scheduled exam period.
STUDENT INFORMATION
Surname (Last) Name First Name
Seneca Student # Email
Daytime Telephone # Ext. Alternate Telephone # Ext.
EXAMINATION INFORMATION
Course Name Course Code (ACC101-N1M)
Course Start Date Course End Date
Date to Write
INVIGILATOR INFORMATION
Note: All exams are sent by traceable courier for tracking purposes.
College/University Test Centre Name
Invigilator’s Name Invigilator’s Title
Address:
Invigilator’s Work E-Mail Invigilator’s Work Telephone # Ext.
Student Declaration: By checking here, I hereby certify that I have completed the above information accurately and I will take the test/
exam under the supervision of an approved invigilator in a professional testing setting/facility.
Invigilator Declaration: By checking here, I hereby declare the information I have provided is correct and the test/exam will be
administered in a professional testing setting/facility.
Note: Exams must be returned using a traceable, guaranteed delivery service.
Any fees for invigilation services, including courier fees, are the responsibility of the student.
FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT
The personal information on this form is collected under the legal authority of the Colleges and Universities Act, R.S.O. 1990, Reg. 770. The information is used for
the administrative and statistical purposes of the College and/or the ministries or agencies of the Government of Ontario and the Government of Canada.
