Student Exam Booking Form - All Campuses

For students with academic accommodations current as of August 2026.

*NOTE: You must complete this form at least SEVEN days before your scheduled exam date.

If your exam is scheduled less than seven days after today's date, your exam booking will not be approved. Please contact your accessibility coordinator if you have questions.

Student name Student name First Last
Selkirk College email address.
For help setting up a Selkirk College email address or resetting your password, visit: https://go.selkirk.ca/display/KB/IT+Student+FAQ
Main Campus of Study for your program
Course name and number (e.g., ENGL 110, CHEM 60, MLMC, WELD FOUND, ELEC Y3)
Instructor name Instructor name First Last
Exam type

Exam type Quiz/Test Midterm Final exam Other (e.g., in-class writing assignment)
Exam Date for Class Exam Date for Class / MM / DD YYYY
Exam Start Time for Class Exam Start Time for Class : HH MM AM/PM
If you are able, you may submit all the tests dates for ONE CLASS on this form.

Please make a list of the dates of all your tests for this class below.

You will have to submit at least one exam booking form for each class.
Add my extra 1.5x or 2x time:
(When choosing your answer please consider classes you may have before or after this exam.
FOR FINAL EXAMS A START TIME WILL BE ASSIGNED.
For Final Exams please select N/A.
If you do not have the accommodation of extra time, please select N/A.)

Add my extra 1.5x or 2x time: (When choosing your answer please consider classes you may have before or after this exam. FOR FINAL EXAMS A START TIME WILL BE ASSIGNED. For Final Exams please select N/A. If you do not have the accommodation of extra time, please select N/A.) Start early (BEFORE your class starts the exam) End of exam time (finish later than class) N/A
Is this a computer-based exam (ie/ Moodle)

Is this a computer-based exam (ie/ Moodle) Yes No
If there are any accommodations listed on your LOA that you DO NOT want to use for this exam, please list them here.
Student signature (type, draw or write in the box below)
Please note: Depending on Selkirk’s exam schedule, you may have a class before or after the exam. Your signature indicates you have acknowledged that your accommodated time may cause you to potentially miss class content.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.