BLW32Mid-Study PeriodExamInvigilator Form

Failure to return this form by Friday of Week 2 may result in you being ineligible to sit your test.
It remains the student’s responsibility to ensure forms are received by the University clearly and on time.

Return completed forms to:Flexible Learning Support

Curtin Teaching and LearningFax: (+61 8) 9266 1734

Curtin UniversityEmail:

GPO Box U1987

PERTH WA 6845

Section A – Student details

Curtin ID Number: / Surname: / First Name:
Address:
Suburb: / Country: / Postcode:
Home Phone: / Work Phone: / Mobile:
Email address: Exam Date: Exam Time:
Signature: / Date:

NOTE: It is essential that this form is submitted withboth the invigilator and student signatures.

Section B – Invigilator details

An invigilator must be a Justice of the Peace (JP), minister of religion, librarian, police officer, teacher, lecturer or other suitably qualified person. Supervisors may not be a friend, relative, work colleague or neighbour.

To confirm the suitability of the invigilator, an email address must be provided which includes the name of their place of employment. Supervisors must be able to speak and read English. Invigilators should ensure that students provide the precise details (i.e. time and date) of the examination before they sign this form. The time and date of all Curtin Open Universities Australia mid-study period examinations is available at to the start of each study period.

Note to Invigilators:

Pleaseprovide a brief statement describing the nature of your relationship to the student that has led to this invigilation arrangement. If you have not known the student before, please declarethis. Do not accept this appointment if you cannot provide your email address from your place of employment.If you are an individual invigilator who requires payment, please note that the recommended maximum rate for individual invigilation services is $100 per exam session.

Supervisor Title: / Surname: / First Name:
Relationship to Student: / Occupation (or J.P. / C.D. Number):
Company Name:
Business postal address:
(must not be a PO Box for courier purposes) / Suburb:
State: / Country: / Postcode:
Work Phone: / Mobile: / Fax:
Email address:
Proposed Exam Venue:
I am available and agree to supervise this student on the date and timespecified above.
Signature: Date:

Office Use Only:Confirmation Sent On DB Date: Staff: