Self-Study Program (SSP) – Level Exam Completion Agreement Form Untitled Name(Required) First Last Level(Required)(select one)12345Trade(Required) Apprenticeship Number(Required) Phone Number(Required)Name of Apprenticeship Program Officer (APO)(Required) Email Address(Required) Check each task completed (all are required to receive approval to write an exam).(Required) I have reviewed the highlighted EXAM RESULTS BREAKDOWN and used it as a guide. I have reviewed the PLAN OF TRAINING. (https://pattern-loop.live/atcd/designated-trades/pots-aacs/plans-of-training-pot/%29%3C/label%3E I have used the learning objectives contained in the COURSE OUTLINE as a checklist for studying. I have applied the memorization technique, discussed during the counselling session to my studies for procedural topics that involve steps and/or lists. I have reviewed the BLOCK EXAM STUDY GUIDE. I have reviewed the STUDY STRATEGIES AND EXAM PREPARATION GUIDE. I have created a weekly Study Plan Timetable to help with organization. I have used the study methods recommended for the three types of questions that may be on the exam (Level 1 – Knowledge/Recall; Level 2 – Mathematical/Procedural; Level 3 ‐ Problem Solving/Critical Thinking). I have thoroughly reviewed and practiced any applicable CODE BOOKS, DIAGRAM BOOKS, and FORMULAS. I have reviewed sample questions from the EXAM BANK website. I have reviewed all other links in the documentation previously emailed to me. INSTRUCTIONS AND CONSENT(Required) I understand I have a minimum of 30 days and maximum of 90 days to complete this Self‐Study Program (SSP). I am aware that exam re‐writes will only be granted after the 30-day waiting period has passed, AND a SSP Completion Agreement form has been submitted for approval. I understand that once the SSP Completion Agreement form has been submitted and reviewed within a reasonable time frame, I will be notified of approval by email, and emailed instructions of how to register for the exam. Signature(Required)To sign your name, use your finger, mouse or other compatible input device inside the dotted box. To start signing, press or click, hold and move. To stop signing, lift or release. To clear the signature, press or click the arrows icon in the bottom right corner.FORM SUBMISSION INSTRUCTIONS: Upon submitting this form, you will receive a message that we have received your form. No need to email us for further confirmation at this point. The form will now be processed, and if approved, you will receive an email to verify completion of the SSP program. The email will also contain the information needed to book your next exam writing. Privacy statement(Required) I agree to the privacy statement.The personal information collected in this form will be used only for the administration of those programs provided by the Government of Newfoundland and Labrador for which the supplier is a participant. This information is being collected in accordance with section 61(c) of the Access to Information and Protection of Privacy Act, 2015 (ATIPPA, 2015). All information provided will be maintained in a secure manner and confidentiality will be protected, as required by the ATIPPA, 2015. For questions or comments related to the protection of your personal privacy, please e-mail SelfStudyPlan@gov.nl.ca
