Clinical Component - Rescheduling Form
Candidate’s name Last First
Candidate’s PIN
I am registered for the exam on (date) Currently Registered in:
Service
(fees are non-refundable)
Before Application Deadline
After Application Deadline and up to 4:30pm EST on the last business day before the exam date you are currently registered in.
Date Change Free Free
Withdrawal Free Free
Date Change - Fill in this section if you want to change your exam date.
• To change exam date to the next calendar year, you must send the relevant exam application form (original copy), and applicable fee increase for the new calendar year.
• You cannot transfer into an exam if the application deadline for that exam has passed.
• Your application will be considered received as of the date your change of date was received, not the date your original application was received. This could affect your site assignment.
Changing your exam date may affect your application for a licence to practice. Contact your provincial or territorial regulator for more information.
I am currently registered with the following provincial/territorial regulator(s): (x all that apply)
BC AB SK MB ON QC PEI NL NS NB YK Not Registered
Please change my exam
date to: New Exam Date:
Signature Date
For Office Use Only: Date received: Date entered:
Currently Registered In:
New Exam Date:
