Application to Write Exams Out of Town

(Go to http://code.sfu.ca/student_handbook/exams_and_grades to see if this applies to you)

Submission Term:

Course: * The course code, ex.: "ARCH 100" or "ENGL 199W"
(Use a separate form for each course.)

Student No: *

First Name: *

Last Name: *

Std. Street Address:

City:

Prov.:

Country:

Std. Postal Code:

Home Phone: *

Std. Other Phone:

Email: * (Attention SFU students: Any non-SFU email address provided will be used for CODE exam-related correspondence only. Other SFU related correspondence sent via email will continue to be sent to your @sfu.ca email address.)

Indicate whether you will be using this exam proctor for the midterm(s), final examination, or both.

All

Mid1 Only

Mid2 Only

Final Only

Proctor Information

(May not be a current SFU distance education student.)

Proc F. Name: *

Proc L. Name: *

Email [MUST be work-related]: *

Proctor's place of business and contact information. Note: All the information must be completed.

Proctor Institution: *

Department:

Address: *

City: *

Province:

Country: *

Postal Code:

Work Phone: *

Other Phone:

Fax:

Website:

Occupation: *

Position Title: *

Provide the proctor's occupation if you selected "other":

Relationship with student: *

Proctor is proficient in English:

Proctors may not be your friend or associate or a member of your immediate or extended family. The proctor may not be a current distance student at Simon Fraser University. If you selected "Other" in the Occupation field, the proctor must be a professional or administrative person employed in the education field of an accredited institution. Proctor occupations that are accepted is very limited and therefore it is in your best interest to contact CODE prior to submitting your application if you selected "other" as the occupation.

Student Notes: