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 UNDERGRADUATE AND DIPLOMA STUDENT
This document is not to be used to declare an intent to graduate. If you have not declared your graduation, you must do this through Aurora or
by
contacting your Faculty/School before proceeding. The fee for a confirmation of Eligibility to Graduate is $11.75. Please allow a MINIMUM of 2
weeks for processing. To be considered as eligible to graduate, you must be enrolled in or have successfully completed the final courses required for
your degree program and any other degree requirements.
STUDENT INFORMATION:
Student Number:
Last Name(s):
Given Name(s):
Previous Name(s) (If Applicable):
Date of Birth:
Daytime Phone:
Specify the Faculty/School you are with (i.e Faculty of Arts, School of Art):
Specify the degree you expect to receive (i.e. Diploma, BA Hons, BSc General):
Check off the program you are in, if you are in the faculty of Engineering: Mechanical
Civil
Biosystems
Electrical
Computer
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 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.
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
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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
To be completed by the Faculty/School 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
degree/diploma and will be eligible for graduation in February
or May or October , 20 ,
subject to University Senate ratification.
Dean/Director’s Representative: Faculty/College/ School:
Date:
Signature:
click to sign
signature
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