Fillable Verification of Enrolment (The Michener Institute of Education at UHN)

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Verification of Enrolment (The Michener Institute of Education at UHN)

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Verification of Enrolment
Registrar’s Office
222 St. Patrick Street Toronto, ON M5T 1V4
regoffice@michener.ca │ 1 (416) 596-3117 or 1 (800) 387-9066
Verification of Enrolment 21-May-2020
Date Received
Office Use Only
Verification of Enrolment letters are produced within three business days of payment being received. Students will be notified by email when the letter is ready for
pickup OR has been sent. Archival searches may be necessary and will require additional time to process.
Student records are confidential. Confirmation letters are only issued when requested through written authorization by the student. Note: Verification of
Enrolment letters will not be released to students who have financial holds on their records.
STUDENT ID: ______________________
DATE OF BIRTH:
MM
DD
YYYY
NAME AND ADDRESS (Please Print Clearly)
LAST NAME
PREVIOUS LAST NAME
MIDDLE NAME
ADDRESS
CITY OR TOWN
PROVINCE
Type of document submitted (CPP, RESP, etc.):
P
OSTAL CODE TELEPHONE EMAIL ADDRESS COUNTRY
Update my mailing address to the above:
Yes No
Number of forms to be completed: ________ X $12.00 Each
Please select ONE of the following options: Pick Up Mail Out Courier (No PO Boxes)* Email (PDF)
*Courier charges: $10 in Canada, $25 in US, $50 International
MAILING ADDRESS (if different from above)
TOTAL AMOUNT: $
___________________
ATTN:
ADDRESS
DEPT:
CITY/TOWN
COUNTRY
PROVINCE
POSTAL CODE
PAYMENT METHOD
Credit Card
Visa
AMEX
MasterCard
Cardholder Signature
Cardholder Name (Please Print)
Date
Other Payment Methods:
Cash
(in person only)
Debit Card
(in person only)
Money Order
Certified Cheque
(personal cheques are not accepted)
EXPIRY DATE
AUTHORIZATION AND DECLARATION: I certify that the information contained herein and in the supporting documents is true, correct, and complete.
Student Signature: _______________________________________________________________
Date:
Processed By: _______________________________________________________________
Date:
The information on this form is collected under the authority of the Michener Institute of Education at UHN and will be protected and used in compliance with the Ontario
Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. F.31. Student information held by the Michener Institute of Education at UHN may be used for
administrative and statistical purposes of the Institute and/or the ministries and agencies of the Government of Ontario and the Government of Canada.
P
rogram Name: _________________________________
A
cademic Year: 2019/2020 2020/2021
[ ] Tick this box if you would like to update the address on file with the address below.
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Verification of Enrolment (The Michener Institute of Education at UHN)

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Completed 10 February 2021

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