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REASSESSMENT AND SUPPLEMENTAL EXAMINATION REQU EST FORM (MacEwan University)

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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
www.MacEwan.ca • recordsunit@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.
REASSESSMENT AND SUPPLEMENTAL EXAMINATION
REQU
EST FORM
PLEASE READ INSTRUCTIONS AND REGULATIONS ON SECOND PAGE BEFORE SUBMITTING THIS FORM
PLEASE CHECK ONE ONLY:
REASSESSMENT OF “FINAL” EXAM - $20 FEE SUPPLEMENTAL EXAM - NO FEE
OFFICE USE ONLY
FEES ASSESSED YY MM DD INITIALS
FEES PAID YY MM DD INITIALS
METHOD OF PAYMENT CASH CHEQUE
VISA/MASTERCARD NO.: _______________ ______________ _______________ _______________
CARD HOLDER’S NAME: ________________________________ EXPIRY DATE: _______________________
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 WISH TO APPLY FOR THE EXAMINATION AS SPECIFIED ABOVE. I HAVE READ THE REGULATIONS AND INSTRUCTIONS ON THE REVERSE OF THIS FORM:
COURSE NO. ______________________________ SECTION ______________________________________ COURSE NAME ________________________________ TERM ________________________________
DATE _____________________________________ STUDENT’S SIGNATURE __________________________________________________________________________
PLEASE CHECK 1, 2, OR 3 ONLY
1. REASSESSMENT OF “FINAL” EXAM. FOLLOWING IS A RESULT OF THE REASSESSMENT OF THE ABOVE COURSE:
NO CHANGE CHANGE GRADE TO ____________ AND REFUND FEE
2. SUPPLEMENTAL EXAM APPROVED FOR THE ABOVE COURSE.
PLACE: _______________________________
EXAM RESULTS: _______________________
DATE: ______________________ TIME: _______________________________
EXAMINER: ________________________________________________________
SUPPLEMENTAL EXAM NOT AVAILABLE.
PART C
EXAMINATION RESULTS UPDATED
DATE: ________________________________ INITIALS: ______________________________________
OFFICE OF THE UNIVERSITY REGISTRAR
METHOD OF PAYMENT
DEBIT CARD (IN PERSON ONLY) CHEQUE MONEY ORDER
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
3.
Clear Form
EXAMINATION REQUEST
REGULATIONS:
1. REASSESSMENT OF “FINAL” EXAM
1.1 The Student may request the reassessment of a final examination by filling out an Examination Request Form and submitting the
requisite fee to the Office of the University Registrar. The application for reassessment shall be made within 15 calendar days from the
official grade posting date for that term (MacEwan.ca).
1.2 The results of the reassessment shall be communicated to the Student & the Office of the University Registrar
as soon as possible by the Chair.
1.3 All programs should provide students the opportunity to review their examination paper.
2. SUPPLEMENTAL EXAM
2.1
2.2
2.3
2.4
2.5
2.6
The Student whose academic performance as determined by the instructor, significantly declines in a course due to poor performance
on a final examination worth more than 40% of a course as specified on the course outline, shall be granted access to a supplemental
examination.
Within 5 working days of the posting of grades, a Student wishing to write a supplemental examination shall contact the program to
ascertain their eligibility for supplementary examination.
The Student must apply to the Office of the University Registrar by the published deadline.
The Student then takes the form from the Office of the University Registrar to the Chair who will arrange for the availability,
writing and marking of the supplemental examination and the Office of the University Registrar shall be informed.
The results of the supplemental examination will be recorded in section B-2 by the instructor and the examination form will be
forwarded to the Office of the University Registrar.
The Student’s record shall clearly indicate “supplemental examination” and the grade earned after the writing of the supplemental
examination.
INSTRUCTIONS: FOR COMPLETION OF THE EXAMINATION REQUEST FORM FOR REASSESSMENTS AND
SUPPLEMENTAL EXAMS
1. The student completes “A” in full.
2. Check the box ( ) at the top of the form indicating the type of exam that you are applying for.
3. Take the examination request form to the Office of the University Registrar for payment for reassessments only.
4. The student takes the form to the Chair or designate to complete the appropriate portion of section B.
5. The results of the examination will be recorded in appropriate portion of Section B by the Program Chair or designate and the
examination request form will be forwarded to the Office of the University Registrar.
6. The Office of the University Registrar will issue the results to the student.
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REASSESSMENT AND SUPPLEMENTAL EXAMINATION REQU EST FORM (MacEwan University)

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Completed 30 January 2021

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