400 UMSU University Centre
Winnipeg MB R3T 2N2 Canada
Tel: 204-474-9420
Fax: 204-269-1065
Email letter to UM student email:
Email letter to third party:
(Please write the full email address here)
EMAIL METHOD:
Request for Confirmation of Eligibility to Graduate GRADUATE STUDENTS
In order for your request to be considered, you must be enrolled in and/or have successfully completed your final degree requirements. The fee for
a
confirmation of Eligibility to Graduate is $11.75. Please allow a MINIMUM of 2 weeks for processing.
Eligibility Checklist
Thesis/Practicum Route
Final Approval form/report to FGS office: Yes
Copyright License Declaration form on MSpace: Yes
Electronic thesis/ practicum submitted to MSpace: Yes
All courses have been completed: Yes
Comprehensive Route
Comprehensive form to FGS office:
Yes
All courses have been completed:
Yes
Course Based Route
Unit has notified FGS of pending graduation: Yes
All courses have been completed: Yes
STUDENT INFORMATION:
Student Number:
Last Name(s):
Given Name(s):
Previous Name(s) (If Applicable):
Date of Birth:
Daytime Phone:
Specify the department/ unit you are with (i.e Immunology) :
Specify the degree you expect to receive (i.e. Diploma, Masters, P.hD):
Check off when you expect to graduate:
February or May or October, 20
Student signature
:
Date
:
MAILED PAYMENT OPTIONS:
Expiry date:
/
Amount:
Date:
Cheques/Money Orders can be made out to“The University of Manitoba”.
Visa or Mastercard Number
_________________________________
CVV# (3 digit number)_________
(Visa Debit is not accepted)
Card Holder’s name (as it appears on the card):
Card Holder Signature:
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 Elligibility to Graduate request. Your personal
information will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection o f 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.
DELIVERY METHOD
(FILL IN ADDRESS BELOW)
:
Postal Code:
Delivery problems arising from the provision of incorrect information are not the
responsibility of the Registrar’s Office.
Standard mail
click to sign
signature
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signature
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400 University Centre
Winnipeg MB R3T 2N2 Canada
Tel: 204-474-9420
DO NOT WRITE BELOW THIS LINE
February or May
or October
, 20
, subject to University Senate ratification.
Faculty of Graduate Studies representative:
Date:
(Signature)
and will be eligible for graduation in
(program completion date)
To be completed by the Faculty of Graduate Studies and returned to the Registrar’s Office
This will serve to confirm that the student noted above is expected to complete / has completed
the requirements for the following
click to sign
signature
click to edit
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