Statement of
Presiding Supervisor
TRU-OL Examinations,
805 TRU Way
Kamloops BC V2C 0C8
Fax: 250-852-6401
Email: exams@tru.ca
truopen.ca
OL21003
GENERAL INFORMATION / INSTRUCTIONS
• This form applies to students unable to write at a BC or CIN Exam centre and
require special arrangements (see below). Note: Students intending to write
their exam outside of Canada are required to contact TRU-OL Exams.
• Complete section A. Request an appropriate supervisor to supervise
(invigilate) your exam and have them complete section B.
• Email the completed form to TRU-OL Exams by the deadline date of
the exam session requested. Additional time may be required for some
special arrangements.
• The information you provide on this form is collected under the Thompson
Rivers University Act (BC) and will be used to administer your request.
• Email questions to exams@tru.ca or phone: 1.800.663.9711 Ext. 3 (toll-free in
Canada) or 250.852.7000 Ext. 3 (Kamloops and International).
A. STUDENT TO COMPLETE (PRINT CLEARLY)
I require special arrangements for the following reason(s):
MORE THAN 100 KM FROM NEAREST EXAM CENTRE
RESIDING OUTSIDE BC/CANADA INCARCERATED
WRITING OUTSIDE EXAM SESSION DATES
(reason and documentation required)
ACCOMMODATIONS APPROVED BY ACCESSIBILITY SERVICES
ENTER TRU STUDENT NUMBER
PERSONAL DATA (PRINT CLEARLY)
BUSINESS ADDRESS—TRU-OL WILL MAIL EXAM(S) TO THIS ADDRESS
B. PRESIDING EXAM SUPERVISOR TO COMPLETE
(PRINT CLEARLY)
TRU-OL requires that the presiding exam supervisor be fluent in wrien and spoken
English, be employed as an educator in a teaching or administrative capacity or be
an employee of a TRU-OL approved Testing Centre. Supervisors cannot be related to
or have a relationship with the student.
EXAM SUPERVISOR NAME POSITION TITLE
PLACE OF EMPLOYMENT
BUSINESS TELEPHONE NUMBER
Area Code
ALTERNATE TELEPHONE NUMBER
LOCAL
BUSINESS EMAIL ADDRESS
CITY / TOWN / VILLAGE
PROVINCE / STATE POSTAL CODE / ZIP CODE COUNTRY
I agree to supervise the exam(s) of the student (A). I read, write and speak English
fluently. I am not a relative of or have a relationship with the student.
I agree that I will ensure that the student will write the exam(s) without assistance
unless noted on the exam papers; all documents will be kept confidential until the
time of writing, and I will not make copies; all exam papers, questions, answers,
answer booklets (including those unused) will be returned to TRU-OL promptly on
completion of the exam, or upon request by TRU-OL.
EXAM SUPERVISOR’S SIGNATURE
DATE (YYYY/MM/DD)
Area Code
REFERENCE: (PERSON YOU REPORT TO)
REFERENCE’S POSITION TITLE
REFERENCE’S EMAIL ADDRESS (Print clearly)
REFERENCE’S TELEPHONE NUMBER
Area Code
LOCAL
ADDRESS WHERE EXAM(S) WILL BE WRITTEN
CITY / TOWN / VILLAGE
PROVINCE / STATE POSTAL CODE / ZIP CODE COUNTRY
MAILING ADDRESS
SURNAME (legal)
FIRST NAME (legal) FULL MIDDLE NAME(S) (legal)
CITY / TOWN / VILLAGE
PROVINCE / STATE POSTAL CODE / ZIP CODE COUNTRY
MAILING ADDRESS (include buzzer code if applicable)
EMAIL ADDRESS (Print clearly)
TELEPHONE NUMBER
STUDENT’S SIGNATURE
DATE (YYYY/MM/DD)
LOCAL
COURSE CODE
COURSE NUMBER
EXAM SESSION
MONTH YEAR
COURSE CODE
COURSE NUMBER
EXAM SESSION
MONTH YEAR
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