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BE PREPARED for your online exam(s)!! Once registered, you will receive an IMPORTANT EMAIL with your login and password. You will need to login to your MyACC account before you can login in to MOODLE to complete your online exams. Before you login to Moodle to complete your exam(s), please ensure you have a pencil, scrap paper and calculator. If you are writing one of these category exams: Agriculture Ground, Industrial, Rural Municipal or Seed Treatment you will need your Field Crop Protection Guide book that you received with your manual. If you need to purchase a Field Crop Protection Guide book (PEST-0000), please contact the ACC Bookstore (see below).

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Exam Registration 2020

Pesticide Certifications www.assiniboine.net/pesticide

STUDENT INFORMATION (fields marked with * are required)

Social Insurance # (SIN) * Student Number (if you have attended ACC before) Gender (M or F)

M F

Last Name * First Name * Middle Initial * Birth date (yyyy/mm/dd) *

Home Mailing Address * City * Prov. * Postal Code *

Home Phone * Business Phone Cell Phone PERSONAL Email*

OPEN BOOK, ONLINE EXAMS *Registration and payment must be received by the Wednesday at 4 p.m. prior to the chosen exam date.*

Please check desired exam(s)/category(s)

To qualify for Pesticide Certification you must successfully complete the Pesticide Core exam and one other category exam.

PEST-0101 Pesticide Core (required)*NEW Manual & Exam 2012-13

PEST-0140 Landscape/Golf Course *NEW Manual & Exam 2015-16

*Note: ONE person per Golf Course or Landscape Co. needs IPM

PEST-0102 Aerial *NEW Manual & Exam 2013-14

PEST-0030 Agriculture Ground *NEW Manual & Exam 2013-14

PEST-0013 Livestock Products

PEST-0004 Forestry

PEST-0010 Mosquito *NEW Manual & Exam 2014-15

PEST-0032 Fumigation/Stored Ag

PEST-0011 Rural Municipal *NEW Manual & Exam 2016-17

PEST-0033 Greenhouse

PEST-0008 Seed Treatment *NEW Manual & Exam 2017-18

PEST-0006 Industrial PEST-0031 Structural

$25.00 PER Exam X # of Exams $0.00

ONLINE EXAMS will take a total of 3 hours (2 exams) to complete and will have a 2 day window for completion. Please allow yourself enough time to complete exams (3 hours) before the window timeframe closes.

APRIL MAY JUNE

April 08th – 09th, 2020 May 06th – 07th, 2020 June 03rd – 04th, 2020

April 15th – 16th, 2020 May 13th – 14th, 2020 June 10th – 11th, 2020

April 22nd – 23rd, 2020 May 20th – 21st, 2020 June 17th – 18th, 2020

April 29th – 30th, 2020 May 27th – 28th, 2020 June 23rd – 24th, 2020

Please contact the ACC Bookstore directly at 204.725.8721 to purchase your course manual(s) or shop online at: https://www.bkstr.com/assiniboineccstore

Page 2 of 2 Exam Transfers/withdraws must be done at least 24 hours prior to exam date and a $25 fee will apply per exam.

PAYMENT OPTIONS Visa MasterCard Cheque/Money Order (payable to Assiniboine Community College)

Card # Expiry Date Cardholder Phone #

Card Holder Name

Company invoicing

Sponsorship authorization gives the college permission to invoice/provide receipt in the Company name for the above named student. Before final grade reports can be released, payment must be received from the Sponsor.

Company Name Telephone Fax

Company Address City Province Postal Code

Contact Name

*Sponsors please note that if you do not complete the sponsorship section the receipt will be made in the student’s name and mailed directly to the student.

If you do not receive an auto-reply, your registration has NOT been received!

Please save your completed form and rename it and then resend by attaching it to an email.

Assiniboine Community College’s collection, use and sharing of personal information is set out in its Privacy Policy and a copy of it is available by request from the FIPPA/ PHIA Coordinator. By submitting your application or registration to Assiniboine you confirm that you consent to the collection and use of your personal information as identified at www.assiniboine.net/privacy

Page 2 of 2 Revision date: July 2014

DECLARATION

I understand the grade I receive on my exam may be disclosed confidentially with my sponsor and Manitoba Ag’s Licensing Agent.

I declare that I have read and understood the information on this registration, including the Notice Regarding Collection, Use and Disclosure of Personal Information and that all statements made with respect to this registration are true and complete. I understand that misrepresentation, falsification of documents or the withholding of requested information with respect to this application can result in cancellation of the registration or dismissal from the college. I accept that any information on falsified documents may be shared with the Association of Registrars of the Universities and Colleges of Canada. By entering my signature, I agree to comply with the regulations of Assiniboine Community College.

By checking this box, I agree to the "Declaration" terms

Clear Form Click here to submit form Print Form

For internal use only: Reg Accts Ag Ext