400 UMSU University Centre
Winnipeg MB R3T 2N2
Canada
Tel: 204-474-9420
Fax: 204-269-1065
Certified Copy of Degree
The fee for a Certified Copy of Degree is $11.50. All areas of this form must be completed. Please allow
approximately five working days for processing.
Name: _______________________ _____________________________ Student Number: ______________
Last Name(s) Given Names
Date of birth: ____________________ Daytime telephone number: __________________________
The University of Manitoba does not have duplicate parchments or any copies of parchments that have been issued to
graduates. Please provide clear copies of your parchment for certification.
• Enclosed are _____ copy(s) of my parchment(s) to be certified.
(number)
If this is a duplicate fax request being sent on the same day, please check here:
Delivery Method (check one):
Pick up myself* Courier** (cannot courier to a PO BOX)
Pick up by a person I authorize*: Additional courier fees will apply:
____________________________________ • $20.00 Within Winnipeg
• $50.00 Anywhere in Canada
(first and last name of person authorizes to collect the document) • $50.00 Anywhere in U.S.A
Mail or Fax** • $100.00 International/Overseas
*Letters not collected will be shredded three months after the original request date. Photo ID will be required upon pick up.
**Please complete the Delivery Information section, below. Delivery problems arising from incorrect information being provided below
are not the responsibility of the Registrar’s Office.
Delivery information:
Recipient Name: ___________________________________________________________________________
Address or Fax: ____________________________________________________________________________
Note: Items cannot be couriered to a PO BOX number.
City and Province/State: ________________________________ Postal/Zip Code: ______________________
Payment: Cash (Cash payments are made in the Cashier’s Office, 138 University Centre, 8:30am to 4:00pm)
Interac/Debit
Cheque/Money Order (Made out to ‘The University of Manitoba’.)
MasterCard or Visa (No other credit cards accepted.)
I hereby authorize payment of $____________ using the credit card and number noted below.
Total amount
Applicant:________________________ Date:__________ Card Holder:___________________________
Signature (Sign only if different from applicant)
Credit Card #: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expiry Date: __ __ / __ __
(for fax and mail-in only) (Month) (Year)
Notice Regarding Collection, Use, and Disclosure of Personal Information by the University
Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University
for the purpose of producing your Certified Copy of Degree document. Your personal information will not be used or disclosed for other purposes, unless
permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of your personal information,
contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.
