PROVINCIAL ASSESSMENT and EXAM REVIEW REQUEST FORM

Note: Personal information is collected under section 26(C) of the Freedom of Information and Protection of Privacy Act. If you have questions about collection of your personal information, please contact the Manager, Education Programs Division through Enquiry BC, 1-800-663-7867 or by mail at PO Box 9183, Stn Prov Govt, Victoria BC V8W 9H1

Review requests must be received by the date specified in the Handbook of Procedures (Chapter 1)
SECTION A: COMPLETED BY THE PRINCIPAL
STUDENT’S LEGAL FIRST NAME*
STUDENT’S LEGAL LAST NAME*
PERSONAL EDUCATION NUMBER (PEN)*
MINISTRY SCHOOL CODE AND SCHOOL NAME*
*
ASSESSMENT TO BE REVIEWED SESSION – MM/YYYY
PRINCIPAL’S EMAIL ADDRESS*
PRINCIPAL’S NAME*
Date*
MM slash DD slash YYYY
SECTION B: COMPLETED BY THE PRINCIPAL on behalf of the STUDENT
Agree and Continue*
By clicking ‘Agree and Continue’ (below) I hereby verify:
• I understand that this request is in accordance with sections 5(2), 9(3)(a) and 9(3)(b) of the Freedom of Information and Protection of Privacy Act (FOIPPA), and that student exams and examination results are protected under the FOIPP Act.

• In accordance with Chapter 1 of the Handbook Of Procedures For The Graduation Program, I have consulted with the student named above (who is in my school) and have been authorized by the student to make this request on their behalf.

• I have clearly established the identity of the student making this request (i.e. PEN, d.o.b. and/or address verified).

• I agree to review these results with the student in a secure setting and dispose of all materials (student exam results and related materials) as soon as the review is completed.
Name
This field is for validation purposes and should be left unchanged.

ASSESSMENT TO BE REVIEWED	SESSION – MM/YYYY

PROVINCIAL ASSESSMENT and EXAM REVIEW REQUEST FORM

SECTION A: COMPLETED BY THE PRINCIPAL

SECTION B: COMPLETED BY THE PRINCIPAL on behalf of the STUDENT