400 University Centre
Winnipeg MB R3T 2N2 Canada
Tel: 204-474-9420
Fax: 204-269-1065
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 Transcript request. 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 Oce (tel. 204-474-9462),
233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.
Student Number: Last Name(s):
Given Name(s):
Previous Name(s) (If Applicable):
Date of Birth:
Daytime Phone:
Student signature: Date:
STUDENT INFORMATION:
I have taken non-degree courses with Extended Education prior to May 2014: Yes NO
TRANSCRIPT INFORMATION:
Total number of Transcripts required :
Current Record OR Pre-order for my upcoming graduation in: February 20 June 20 October 20
DELIVERY METHOD (FILL IN ADDRESS ON THE REVERSE):
Standard Mail
Pick up myself
Pick up by third party:
(rst and last name of person authorized to collect the document)
PICKUP METHOD: Photo ID will be required upon pick up.
Requests not collected will be shredded six months after the original request date. Delivery problems arising from the provision of incorrect information are not the responsibility of the
Registrar’s Oce.
REQUEST FOR TRANSCRIPT
The charge for each Transcript is $14.55. Please ensure that all required grades are visible in Aurora prior to ordering.
Please allow five business days for processing.
The following section is not required for in-person orders:
FAXED OR MAILED PAYMENT OPTIONS:
Visa or Mastercard Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expiry date: __ __ / __ __
Card Holder’s name (as it appears on the card): Amount: $
Card Holder Signature: Date:
(Visa Debit is not accepted)
Cheques/Money Orders can be made out to “The University of Manitoba.
Cash payments.
Cheques/Money Orders made out to “The University of Manitoba.
CASHIER’S OFFICE PAYMENT OPTIONS: 138 UNIVERSITY CENTRE
Visa, Mastercard and Debit.
REGISTRAR’S OFFICE PAYMENT OPTIONS: 400 UNIVERSITY CENTRE
Cheques/Money Orders made out to “The University of Manitoba.
Courier (cannot courier to a PO BOX)
Additional courier fees will apply:
• $20.00 Anywhere in Winnipeg
• $50.00 Anywhere in Canada
• $50.00 Anywhere in U.S.A.
• $100.00 International/Overseas
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signature
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signature
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Please send my Transcript(s) to the following address(es):
(Please specify the recipient’s name, room number, oce, building,
street address, city/town, province/state/region and country)
Delivery Information:
Quantity:
Postal Code:
1.
2.
3.
Postal Code:
Postal Code:
DO NOT WRITE BELOW THIS LINE
Postal Code:
4.
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