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Higher Education Administration – Program Application Form

STUDENT RECORDS:
Have you ever previously registered for any Extended Education course, or applied for a program at the University of Manitoba?  
What is your student number:*
Program/faculty you applied to:
Year of Application:
Last year registered at U of M:
STUDENT INFORMATION:
Title:
Last Name:*
First (Given) Name:*
Preferred First Name:
Middle Name(s):
Date of Birth (yyyy-mm-dd):*
Home Address:
City/Town:
Postal Code:
Day Phone:
Evening Phone:
Email:*
Citizenship: *



OCCUPATIONAL HISTORY: (PLEASE COMPLETE IN FULL)
Job Title:
Employer:
Employer Address:
City/Town:
Province:
Postal Code:
Business Phone:
Business Fax:
Preferred Mailing Address* 



EDUCATION HISTORY: (PLEASE COMPLETE IN FULL)
Highest level of formal education achieved:
Name of educational institution:
Location of educational institution:
Date:
Additional training/courses completed or professional standing achieved:
Date:
What are your educational goals in applying for this program?
Where did you first hear about this program?


APPLICATION FEE

The application fee for this program is $100.

Please indicate method of payment. We will contact you to collect payment.*