Candidate Name (required) Candidate Email (required) Candidate Language (required) —Please choose an option—EnglishFrancais Candidate Address(required) Candidate City (required) Candidate Province (required) —Please choose an option—ABBCMBNBNLNSNTNUONPEQCSKYT Candidate Postal Code (required) Candidate Phone Number (required) Assessment Location Requested: —Please choose an option—West 2023-H1East 2023-H1West 2023-H2East 2023-H2West 2024-H1East 2024-H1West 2024-H2East 2024-H2West 2025-H2East 2025-H2 Your mentor must hold must hold a Level 3 certificate or higher. Mentor Name Mentor Certification Level —Please choose an option—Level 3Level 4 Mentor Email Address Note: Size of files uploaded must be less than 3MB and one of the following file types: gif png jpg jpeg pdf msg bmp Upload copy of Association Member Receipt Upload copy of Assessment Fee Receipt Upload passport type photograph Optional notes/comments for Assessors regarding any limitations or special circumstances: I affirm my intention to sit the assessment and give consent that my application for assessment will be shared with the assessment team and the results of my assessment will be sent by email to my mentor for review and consultation. NOTES: 1) Upon submission of this form, your mentor will receive an email (copied to you) to complete your recommendation. 2) Once all documentation is complete, the candidate’s placement will be confirmed in the assessment applied for on a first-come basis (4-6 candidates maximum per assessment). 3) Final recommendation is due four months prior to the assessment date.