Request for Extension or Exemption:

Annual QA Requirements

The College may grant an extension or exemption to a registrant for completion of their annual Quality Assurance requirements, upon written request. Each request is considered on a case by case basis. Should you wish to request an extension or exemption please submit this form at least two weeks prior to the quality assurance requirement deadline [by October 17 for Self-assessment and Prescribed Regulatory Education Program (PREP); by May 17 for Professional Development (PD) Plan]. Please complete this form and return it to the College by email to Seema Sindwani, Manager, Quality Assurance at: ssindwani@coto.org. Questions about this form or your request? Contact Seema at Phone: (416) 214-1177 x227 I Toll Free: 1 (800) 890-6570 x227
Registrant Name: Registration Number: Day-time telephone number: Email address:
Please check the appropriate box to indicate your request: An extension of time to complete the requirement Requested due date for Self-assessment (originally due October 31): Requested due date for PREP (originally due October 31): Requested due date for PD Plan (originally due May 31): An exemption from the requirement for this registration year

Please check the appropriate box indicating the reason for your request: Major illness or crisis of self or family member Not currently practising/working until: On parental leave until: On leave of absence until: Other:
Please provide details to help us better understand the nature of your request and the length of extension you are requesting, if applicable:
Date: Signature:
*Please note: Repeated requests for an extension with annual Quality Assurance requirements may result in a referral to the Quality Assurance Committee (QAC) for a review and follow-up. For more information please refer to the Compliance with Quality Assurance Program Requirements policy here.
For College Staff Only: Date form received: Date form reviewed: Staff Reviewer: Documents Attached: Extension/Exemption granted: Yes No Date extension/exemption granted: Signature: