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 an individual basis. Should you wish to request an extension or exemption please submit this form as soon as possible. Please complete this form and return it to the College by email to the Quality Assurance program at: qaprogram@coto.org. If you have any questions, you can contact us at qaprogram@coto.org or by phone at 416-214-1177.
Registrant Name: COTO Registration Number: Phone number: Email address:
Please check the appropriate box to indicate your request: Extension to complete the Annual Learning Plan Extension to complete the Annual eLearning Module Annual requirements are originally due October 31. Requested extension date Exemption from one (1) requirement for this registration year Exemption from both (2) requirements 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:
In this section, you have the opportunity to provide details about the reason for your deferral request.
Date: Name:
For College Staff Only: Date form received: Date form reviewed: Staff Reviewer: Extension/Exemption granted: Yes No Date extension/exemption granted:

College of Occupational Therapists of Ontario

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T 416.214.1177 • 1.800.890.6570 F 416.214.0851 (confidential QA fax)

www.coto.org

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