Test Review Request

Test Review Request
To complete this form on your computer you must first download it. Alternately, you may print the form, fill it out, and send it by
email attachment, fax, or by letter mail. The contact information is found at the bottom of this form.
If your test result is below the passing mark (75%) but higher than 65%, you can request a review.
The sole purpose of this review is to confirm that the interpretation of the answers to the test, the application of the scoring key, and the
calculated results are correct.
This request must reach SOFAD within 60 days following the publication of the test results.
Personal information (please print)
Last Name
First name
Home telephone No.
Telephone No. at work
Area code
Area code
Number
Email
Number
Examination identification
Please indicate the examination for which you want the correction to be reviewed.
Examination title
IN
Common
Sale
Use
Examination
Tronc
Utilisation
Vente
Examen
ENENGLISH
of
FRANÇAIS
des
commun
Pesticides
à Core
l'intention
pesticides
des
for
pesticides
for
pour
workers
– Pesticide
in
Aerial
Application
Cultivated
Retail
Wholesale
Agriculture
–des
les
Vente
utilisateurs
préposés
–who
en
Sales
Application
Application
milieu
Users
au
en
Lands
(classes
apply
(Class
by
for
in
on
détail
gros
Buildings
Ornemental
attitrés
Fumigation
Raw
Extermination
the
agricole
pesticides
de
(classes
4),
(classe
1Control
pesticides
en
par
pour
sur
Lands
toPart
àterrain
bâtiment
horticulture
5)
les
aéronef
fumigation
l'application
for
1le
extermination
4),
and
Iterres
II
àto
Horticulture
contrôle
of
Horticultural
5)
Partie
lawns
Retail
Stinging
inculte
etàcultivées
au
des
Iornementale
II
Sales
des
détail
defins
Insects
pesticides
insectes
(classes
Purposes
horticoles
(classes
piqueurs
1sur
1toàles
3) pelouses
Examination
date
Test
score
Method of payment
Cost per examination $20.00
Credit card:
Visa
MasterCard
monthyear
Sub-total
No: plus applicable taxes
Expiration date:
You can also send this form making sure to enclose, if appropriate, a cheque or money order.
Attached:
money order
cheque
Payable to SOFAD
If you are paying by check there will be an additional 10-business day delay in processing
your file from the time the check is received.
Once you have duly completed this form,
please send it to the address noted below or by email or fax.
GST
No 141227892 RT
PST
No 1018814907
Total
A receipt will be issued.
Note:These fees are not
refundable.
Customer Service
SOFAD
2200, Sainte-Catherine Street East, Montreal, Quebec H2K 2J1
Telephone No.: 514 529-2801 or 1 866 840-9346 – Fax No.: 514 529-4788
Email: [email protected]
I confirm that the information provided above
is proof of my examination registration with
SOFAD.
(2016-10-04)