REQUEST TO WRITE A CONCORDIA UNIVERSITY EXAM AT AN EXTERNAL INSTITUTION

Office of the Registrar

(PLEASE PRINT)

30

Family Name First Name Home Telephone E-mail Procedure: 1. Deadline for submission: November 15
April 1 June 1 August 1 2. Fee
( )

Concordia I.D. Number Date of Birth Business Telephone

DAY MONTH YEAR

NOTE: If you change your address please update your Portal accordingly.

for December final examination period for April-May final examination period for June final examination period for August final and replacement/supplemental examination periods

$10.00 per exam to cover costs (non-refundable)

Reason / Courses I am requesting authorization to write my final, deferred/replacement or supplemental examination(s) at an

external institution for the following reason:

I have attached the appropriate documentation supporting this request. The examinations I want to write externally are for the following course(s): SECTION DATE AND TIME OF EXAM COURSE NAME COURSE NUMBER SESSION
e.g. ACCO _________________ _________________ _________________ 213 _______________ _______________ _______________ 2 __________ __________ __________ AA __________ __________ __________ ____________________________________________ ____________________________________________ ____________________________________________

External University / College Information:

Name of University / College Name of Registrars Office Contact

Mailing Address ( ) ( Fax ) E-mail

Telephone

Regulations:
1. 2. 3. 4. 5. This application must be submitted to the Birks Student Service Centre (LB 185) by the deadline noted above along with the necessary fee. You must provide all the relevant information regarding the External University / College Contact. The external institution chosen must be an accredited University / College and the proctor / invigilator must be an employee of that institution. You must write the examination(s) at the external institution at the exact same date and time as scheduled at Concordia and time differences must be taken into account. You are responsible for any invigilation costs required by the external institution.

Students Signature OFFICE USE ONLY

UES721 73100
PAYMENT METHOD DATE:

Date
AMOUNT: INITIALS:

D/C

MO
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