Rescheduling Form –2020 /2021 Clinical Component
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 $100 $500
Withdrawal $300 $500
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 (originalcopy), 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 youroriginal application was received. This could affect your site assignment.
• Email your form to: csc_exams@alliancept.org
• *Withdraws/Transfers received after 4:30 p.m. EST on the last business day before the exam will be considered a “No Show” on exam day and you will forfeit the entire exam fee.
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:
