400 University Centre
Winnipeg MB R3T 2N2 Canada
Tel: 204-474-9420
Fax: 204-269-1065
IMPORTANT NOTES: Prior to submitting an appeal, you are encouraged to speak with your academic advisor to discuss your circumstances and appropriate action. You must have
withdrawn from the course(s) (VW) or have obtained an authorized withdrawal (AW) from your faculty, school or college before ling an appeal; appeals will not be considered
for courses that are showing nal grades. Appeals dating back more than three academic years will not be considered. If you need help, consult with the Student Advocacy Oce
prior to submitting your appeal.
Last Name(s): First Name(s):
Student Number: U of M Email:
I am appealing the following:
Late Registration fee(s) for the following term(s): All tuition fees for the following term(s):
FGS Continuation Fees for the following term(s): FGS Program Fees for the following term(s):
Tuition fees for the course(s) listed below:
e.g. PSYC 1200
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 processing your Tuition Fee Appeal. 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
Signature: Date:
Appeal Explanation:
1. Attach a typed explanation of the reason for your appeal (1 page maximum), AND,
2. Identify which of the following reasons apply to your appeal, AND,
3. Include all required documentation applicable to your reason for the appeal, as listed in the table below.
Additional documentation may be requested, depending on the circumstances
Course: Term: Fall 20___ Winter 20____ Summer 20____
Course: Term: Fall 20___ Winter 20____ Summer 20____
Course: Term: Fall 20___ Winter 20____ Summer 20____
Course: Term: Fall 20___ Winter 20____ Summer 20____
Course: Term: Fall 20___ Winter 20____ Summer 20____
Communication regarding tuition fee appeals for current students will be sent to your UofM email account.
Reason for appeal (Please note Financial diculties are not grounds for a fee appeal) Required documentation to submit with appeal
Medical Grounds:
Medical Grounds include psychological problems documented by a psychologist or psychiatrist.
Healthcare Provider Statement(s)
(e.g. documentation provided by a physician, psychologist, psychiatrist, dentist, etc.)
Critical Illness:
Illness or death of an immediate family member or similar circumstance.
Death Certicate/Obituary
Healthcare Provider Statement(s)
Proof of travel if required (i.e. Boarding Pass)
Relocation due to employment commitments of the student, spouse, parent or guardian.
Proof of travel if required (i.e. Boarding Pass) and
Statement from employer
Military Commitments:
Unforeseen military commitments that interfere with studies
Document from Commanding Ocer
Late Evaluation of Transfer Credit(s):
Evaluation of transfer credit towards a University of Manitoba program was received late
Statement of Transfer Credit
Administrative Situation:
Change of level in graduate program, administrative error or oversight.
Letter of support from program/Student Advisor
Unique circumstances that do not fall in the above categories.
Documentation will be situation dependent
April 16, 2018
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