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Application for Online Exam Site and Proctor
Complete this form to request a student-arranged online exam session. Make sure to note your exam location and proctor's contact information before you begin the complete the form.

Please note that your credit union is responsible for payment of the proctor and exam location for all student-arranged exam sittings.

Use of personal laptop/computer is not permitted for use of exam. Please ensure the location you choose can provide suitable computer

If you have any questions during this process, please email clientsolutions@ccua.com.

Email address *
Contact Information
Enter your contact information and indicate if you are a student or CU Administrator.
Full Name *
Your answer
Email *
Please enter the same email as you use for the Learning Gateway.
Your answer
Phone Number *
Please use the format 000-000-0000
Your answer
Credit Union *
Your answer
Exam Date and Location
Choose a date and time for the exam.

Please note: If you are requesting a different exam date or time, a special request must be submitted by email to clientsolutions@ccua.com first.

Time *
MM
/
DD
/
YYYY
Time
:
Exam Site Name *
Your answer
Exam Site Address *
Your answer
Exam Site City & Province *
Your answer
Exam Site Postal Code *
Please use format A9A 9A9
Your answer
Exam Proctor
Please fill in all the details about your proctor.
Proctor's Full Name *
Your answer
Proctor's Occupation
Your answer
Proctor's Designation
Your answer
Proctor's Email Address *
Your answer
Proctor's Phone Number *
Please use format 000-000-0000
Your answer
Proctor's Fax Number *
Please use format 000-000-0000
Your answer
FOR STUDENTS ONLY
Only choose an exam if you are a student completing the form.

CU Administrators will choose an exam for each student, on the next page.

Exam
Please indicate if this is a re-write
Notes
Your answer
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