Confirmation of Degree Awarded
400 UMSU University Centre
Winnipeg MB R3T 2N2
Canada
Tel: 204-474-9420
Fax: 204-269-1065
The fee for a Confirmation of Degree Awarded document is $11.75. All areas of this form must be
completed. Please allow approximately five working days for processing.
Name:
Student
N
um
ber:
Last Name(s) Given Names
Da
te
of bi
r
th
:
D
aytime
te
lepho
ne
num
ber:
D
egree
(s) to
be
c
onfi
rme
d
:
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 Anywhere in Winnipeg
(first and last name of person authorized to collect the document)
•
$50.00 Anywhere in Canada or 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:
Rec
ipi
e
nt
Name:
Add
re
ss o
r
Fax
:
Note: Items cannot be couriered to a PO BOX number.
Ci
ty
and
Prov
in
ce
/St
ate:
P
os
t
al/Zip Cod
e:
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
Applican
t:
Da
te:
Card Hold
er:
Signature (Sign only if different from applicant)
C
red
i
t
Ca
r
d
#:
- - - Expi
ry
Da
te:
/
(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 Confirmation of Degree Awarded 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.
