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Distance Education > Off-Site Examinations > Off-Site Exam Request Form

eServices Office
Off-Site Exam Request Form

Please complete all Sections on this request form to write your exam at another post secondary institution. Please read and ensure you follow the instructions on the Off Site exam information sheet. Students are required to submit this request form two weeks prior to the on-campus exam date in order for the exam arrangements to be processed on time. A separate request form is required for every exam.

IMPORTANT NOTE:
Please confirm with your instructor the format (e.g. multiple choice, case study, etc.) of any exam that is not scheduled to coincide with the on-campus exam (Toronto time) as the format may not be the same as the on-campus exam.


(Fields marked with a * are mandatory)

PART A
Student Information:
First Name*:
 Last Name*:
YorkU E-mail Address*:
  Student Number*:
Current Address:
Address on Location*:
(e.g. 123 Main St, NewYork, USA)
City*:
 Province/State*:
 Country*:
Postal Code*:
 Cell Phone Number*:
* I confirm that the local/current location and address I reside and have provided above is the same location I will be writing my exam, and that it is more than 3 hours travel time from York University's Keele Campus in Toronto, Ontario Canada.
Permanent Address:
Address*:
City*:
 Province/State*:
 Country*:
Postal Code*:
 Home Phone Number*:
Course Information:
Course ID#*:
(e.g. ADMS 3530 G)
 On-Campus Exam Date*:
 On-Campus Exam Time*:
Course Instructor's name*:
 Time Zone Difference*
(how many hours ahead or behind Toronto time):
Reason for not attending On-Campus Exam*:
 Special needs:

If you are a student registered with the offices noted below, please forward the official documentation that confirms your registration and accommodation/special needs to our office.
 
PART B
Invigilator Information:
 Invigilator Name*:
  Academic Position Title*:
 		Academic Institution, University/College or other*:
Institution Mailing Address*:
 Institution City*:
 Institution Province/State*:
Institution Country*:
 Institution Web Address/URL:
Telephone Number*
(Please include area code numbers):
Fax Number*
(Please include area code numbers):
E-mail Address*:
(Official academic e-mail only, commercial e-mail accounts not acceptable, e.g. hotmail, g-mail)
Off-Site Exam Date Scheduled*:
 Off-Site Exam Scheduled Start Time*:
 
PART C
Fee Information:
Distance Education Fee charge for every exam: Within Canada & Outside Canada $30
Payment made: Yes No 
Payment to be submitted: In person By mail

Please submit cheque or money order (payable to York University) to this department directly, prior to the exam date.

eServices Office
2120 Technology Enhanced Learning Building
York University
4700 Keele Street, Toronto, Ontario, M3J 1P3

Phone number: (416) 736-5831,Toll Free Number (in North America) 1 (866) 261-1790
Fax number: (416) 736-5637
E-mail: deexams@yorku.ca
Internet: www.yorku.ca/laps/disted

REMINDER: Students are required to submit this request form two weeks prior to the on-campus exam date.

Off-site Exam Cancellations: Students are required to inform our office, the host institution (invigilator), and the instructor prior to the off-site exam date and time. Failure to notify the parties listed above before the off-site exam date and time could result in the loss of your off-site exam payment.
Academic Honesty:

"By signing your name you affirm that you are registered in the course. You also acknowledge understanding that cheating on an exam, including impersonation and plagiarism, is a breach of Academic Honesty and is punishable under the regulations of the Senate of YorkUniversity.”

Please review the York University Senate Policy on Academic Honesty #: Sen 002 at: www.yorku.ca/univsec/legislation/senate/acadhone.htm
Today's Date:
 Student Initials to verify that all information supplied here is valid*: