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RETURNING STUDENT CONTINUANCE FORM Section 1: Continuance at (Canadian Mennonite University)

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RETURNING STUDENT CONTINUANCE FORM
Section 1: Continuance at CMU
Indicate when you plan to return to CMU: Fall session (September) Year:
Winter session (January)
Year:
Spring/Summer session (May) Year:
Pa
rt-time Undecided
Student ID:
Given Name:
Previous or Other Names (Surnames):
City/Town:
Postal/Zip Code: Country:
Cell: _______ Email:
___ __
Separated/Divorced
I plan to return: Full-time
Section 2: Personal Information
Mr. Ms. Miss. Mrs.
Surname:
Middle Names:
Current Address:
Province/State:
Telephone: ______ _
Date of Birth: (D
D/MM/YYYY)
Gender: Male Female
Marital Status: Single Married
Are you a Canadian Citizen: Yes
No If not Canadian, check one: Permanent Resident* Refugee Study Permit*
*Photocopy of document must be sent with application. Original document must be presented upon arrival.
Place of Birth: Citizen of:
Primary Language (refers to ‘mother tongue’): English French Other (specify):
If you are of Aboriginal ancestry, please specify: First Nations (status) First Nations (non-status) Inuit Metis Other
(By declaring your status, you will help in the development of new services and events for Aboriginal students. The declaration is voluntary)
Home Church (if applicable): Denomination:
Not affiliated with any church or denomination
Section 3: Previous and Current Education
Have you ever registered or you are currently registered at a post-secondary institution: Yes No
If yes, complete the below section.
List in chronological order the colleges and/or universities attended:
Name of Institution Location Dates Attended Credential Earned
I have requested and/or supplied official transcripts.
RETURNING STUDENT CONTINUANCE FORM
Section 4: Program Information
Please indicate the degree program you intend to complete at CMU (eg. BA, BBA, BMus, BMT, pre-professional studies) and majors
(eg. psychology, IDS).
THIS IS NOT A PROGRAM DECLARATION FORM.
Section 5: Medical Information
Provincial Health Insurance (name of province and policy number):
Private Insurance (name of provider, policy number and phone number. For Americans and also for Canadians with additional
coverage):
In order to serve you better, please disclose information that may require accommodation for physical, learning and mental health
reasons. This could include any physical limitations, learning disabilities, allergies, or mental health issues you have. This declaration
is voluntary. Please note, CMU strives to provide a fair and supportive learning environment for academically qualified students with
disabilities. Here, disabilities include both mental and physical conditions, which meet the following criteria: The condition is
permanent, ongoing, episodic, or of some persistence, and the condition causes a significant limit for the person in carrying out
some of life’s major activities:
Section 6: Housing Information - Contact the Residence Director at (204) 487-3300 and complete a housing application form (found on the website)
I agree to familiarize myself with Canadian Mennonite University policies (including withdrawal and exam dates) and to honour all financial obligations.
Note: Your personal information provided on this form will be used by CMU for purposes of admission, registration, and communication with you. Your information
will be provided, as required, to Statistics Canada, to the Council on Post-Secondary education in Manitoba, and to other authorized government departments. Your
name, address, year-level, church affiliation, declared program, and the name of your high school will be shared with CMU’s offices working with External connections
including student recruitment, development, and alumni. Alumni records will be maintained indefinitely for purposes of maintaining contact with former students.
Signature: Date: (DD/MM/YYYY) __ __
Registrar’s Office
Canadian Mennonite University
500 Shaftesbury Blvd
Winnipeg, MB R3P 2N2
Ph. (204) 487-3300 Toll Free: (877) 231-4570
Fax: (204) 837-7415 Email: spenner@cmu.ca
Office Use Only:
Transcripts Received: Yes No N/A
Re-admitted: Yes No
Signature:
Date: (DD/MM/YYYY) / /
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RETURNING STUDENT CONTINUANCE FORM Section 1: Continuance at (Canadian Mennonite University)

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Completed 30 January 2021

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