Student Registration Form Student Registration Form POLICIES Refunds I have read and understood the Refund Policy. Privacy I consent to the collection, use, and retention of all personal information in this application form by PT EXAM PREP, and to the use of this information as outlined in the Privacy Policy. Spam I provide express consent to PT EXAM PREP to communicate with me using the email address I provide in my application. This includes future student information updates, announcements, event/seminar invitations, surveys, contests and other notifications. This also includes the sharing and exchanging of any personal information I provide in the application, as defined in the Privacy Policy. Confidentiality I understand I will be provided with course materials that are considered the intellectual property of PT Exam Prep. I hereby agree that I will not at any time or in any manner, either directly or indirectly use the course materials for personal benefit, gain or advantage. I will not share the course materials with others, leave them unattended, or stored in an unsecure location (both physically and digitally). Proprietary course materials include but are not limited to: all student course hand-outs, questions, answers and photos/charts. All mock exam questions and answers. STUDENT INFORMATION First & Last Name * Pronouns She/HerHe/HimThey/ThemOther Let us know how to refer to you. Not a required field. Address * City * Province * Postal Code * Email Address * Confirm Email Address * Primary Phone * Alternate Phone From what school did you graduate? * Have you attempted this exam before? * Yes, once before.Yes, this is my last chance.No, this is my first attempt. What are you areas of strength and weakness? (This information will be shared with your teacher before the class begins) * Course Type * WrittenClinical When will you be taking your exam? * Written PCE - January 22nd, 2025Written PCE - February 26th, 2025Written PCE - March 26, 2025Written PCE - April 23, 2025Written PCE - May 28, 2025Written PCE - July 23rd, 2025Written PCE - August 27th, 2025Written PCE - September 24th, 2025Written PCE - October 22nd, 2025Written PCE - November 26th, 2025BC Alternate Clinical Evaluation - February 22, 2025Alberta Post-Graduate Clinical Examination - October 19th or 20th, 2024Alberta Post-Graduate Clinical Examination - February 22nd or 23rd, 2025Alberta Post-Graduate Clinical Examinatino - May 10, 2025Alberta Post-Graduate Clinical Examination - October 18th or 19th, 2025Ontario Clinical Exam - January 24th or 25th, 2025Ontario Clinical Exam - March 28th or 29th, 2025Ontario Clinical Exam - May 31st or June 1st, 2025Ontario Clinical Exam - October 18th or 19th, 2025 When will you be taking your exam? Which course are you registering for? * Ontario's Clinical Exam CoursePremium Access Video CourseBasic Access Video CourseCanadian Student Written Course FEEDBACK How did you hear about PT Exam Prep? * FriendInternet SearchFacebookInstagramFree WebinarsOther How did you hear about PT Exam Prep? If you selected "Other" above, please tell us how you heard about us! reCAPTCHA If you are human, leave this field blank.