Application for Final Examination
Independent Studies, Online, CERTESL Classes
Spring 2015 Session: June 22, 2015
T1 Classes
Please return this completed form by May 22, 2015
Students who are not writing in Saskatoon must complete this
final examination form.
Mail: CCDE Examinations, 464 Williams Building
221 Cumberland Avenue North, Saskatoon, SK S7J 1M3
Email: [email protected] (attach a scanned or photographed form)
*Ensure your name is in the email subject line
CCDE Exam Office
For more information or assistance with
your exams, call us at 1.306.966.4811,
Monday to Friday, 8:30–12:00 & 1:30–4:30 CST,
or email: [email protected]
Fax: 1.306.966.5245
Student Contact Information: to be completed by student (please print).
First name
Last Name
NSID # (ABC123)
City/Town
Mailing address (street address or box number)
Province/State
Phone number (work)
Country
Phone number (cell)
Postal Code
Fax
Phone number (home)
Email (University email only—[email protected])
A. Final Exam Schedule (T1)
Please check the class(es) in which you are writing a final examination. Contact the CCDE Exam Office if you have a scheduling conflict
with another examination, or you are writing more than 2 exams.
Monday, 9:00 am
Monday, 2:00 pm
q ENG 224 • W01
q GEOG 120 • W03
q SOC 225 • W03
q GEOG 351 • W03
q GEOG 386 • W01
q SOC 233 • W01
q W6ST 201 • W03
June 22, 2015
June 22, 2015
Fill in either Section B or Section C, but not both.
Students registered through DSS (Disability Services for Students) are required to fill out sections A and C.
B. Regular Centre Examination
Please choose the site where you will write your exam.
❍ Prince Albert ❍ Regina
If you are not able to write at one of the regular centres above, please go to Section C (page 2 of this form) to request a Special Centre.
(See Student Information Handbook at ccde.usask.ca/distanceeducation/courses-fall for more information).
You can verify date and time of your exam(s) on PAWS. The location listed is for people writing in Saskatoon.
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Application for Final Examination (page 2)
Independent Studies, Online, CERTESL Classes
C. Special Centre Examination
Please fill out this section if you are not able to write at a Regular Centre
Reason for requesting a Special Centre (please check one):
*Disability Services Information: If you have a diagnosed disability (learning,
medical, physical, or mental health), you are strongly encouraged to register
with Disability Services for Students (DSS). In order to access DSS programs and
supports, you must follow DSS policy and procedures. If you suspect you may have
a disability, contact DSS for advice and referrals. For more information, see www.
students.usask.ca/disability/, or contact DSS at 306.966.7273 or by email: dss@
usask.ca
q I live more than 110 Km from any Regular Centre
q I am writing 5 or more exams
q I am registered with Disability Services at the U of S*
q I am not able to write on scheduled day for religious reasons
Students registered through DSS must return the
completed Special Centre form to CCDE in order to
write your final exam(s).
To be completed in full by your invigilator (please print)
Title (Dr/Ms/Mrs/Mr/etc)
Mailing address
First name
Last Name
Business q Residence q
City/Town
Phone number (home)
Province/State
Phone number (work)
Email
How long have you known the student?
Country
Phone number (cell)
Place of Employment
Postal Code
Fax
Job Title
What is your relationship to the student?
Please read the following declaration carefully before signing
I agree to act as invigilator for the above-named student. I will ensure that the examination(s) are written on the scheduled
date and that the examination(s) are kept in a secure place until that date. I agree to administer the examination(s) according
to the regulations provided by the University and to return the written examination(s) promptly upon completion. Under no
circumstance will I allow the student to handle the examination package after completion. I certify that I am not a friend, a
co-worker, a neighbor, or a relative of the above-named student. I do not reside at the same address as the student, nor am I
currently registered in a distance education course at the University of Saskatchewan.
Invigilator signature
Date
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