STUDENT SENATE ELECTION CERTIFICATION
TO
: Mr. Jeff Leclerc, University Secretary
This is to certify that the following candidate(s) was/were elected to Senate for the 20___/20___ session
as the representative(s) of the Faculty/School/College of at
elections held on .
1. Mr. Ms Mrs. Name:
UofM Email Address:
Full Mailing Address:
Phone Number:
UMNetID: Student Number:
2. Mr. Ms Mrs. Name:
UofM Email Address:
Full Mailing Address:
Phone Number:
UMNetID: Student Number:
3. Mr. Ms Mrs. Name:
UofM Email Address:
Full Mailing Address:
Phone Number:
UMNetID: Student Number:
Date: Returning Officer Signature:
Returning Officer (Senior Stick) Name:
Phone No.: UofM Email:
Please return completed form to the Office of the University Secretary:
By mail to 312 Administration Building
By fax to 204-474-7511
By email to Sandi.Utsunomiya@umanitoba.ca
or call 204-474-8174
CLEAR FORM
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