Title * - Select -Mr.MrsMissMs. First Name * Last Name * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002 Street Address * City * Province * - Select -British ColumbiaAlbertaSaskatchewanManitobaOntarioNova ScotiaNew BrunkswickNewfoundland and LabradorPrince Edward Island Postal Code * Phone Number * Email Address * Please ensure you provide a personal email address. (Not your college program email address) Program * - Select -AndersonBCITStenberg Hybrid ( Online Course)VIIMTMohawkSt. ClairCCNBOTHER: Foreign CandidateOTHER: Reinstatement Exam * - Select -CSCT Certification FIRST attemptCSCT Certification REWRITE Graduation Date * Indicate the date of your Graduation or expected date of Graduation Do you require a special accommodation - None -yesno If you choose YES, you will have to provide supporting documentation for this request. ex. letter from your physician, letter from your program head. There maybe a FEE associated to accommodate the request and will be due prior to challenging the exam. Specify special accommodation being requested Supporting documentation will be required before request is approved Name - as you want it to appear on the CSCT Certificate * Exam Fee * $ Exam fees - $600 Language of Exam * English French The exam is offered in both Canadian official languages. Please select one. PayPal account username * Indicated the full name or email address on the Paypal account you are using. Application will not be processed until fees are paid.