Registrar’s Office
400 University Centre
The University of Manitoba
Application for
Winnipeg, MB R3T 2N2
Canada
M
R
S
INNESOTA
ECIPROCITY
TATUS
Tel: 204.474.9420
Toll Free: 1.877.474.9420
Fax: 204.269.1065
Under the Manitoba-Minnesota Reciprocity Agreement, any student who is a resident of the state of Minnesota, as defined by the
University of Manitoba, is granted reciprocity fee status following application, submission of required documentation , and confirmation
by the Registrar’s Office. This status grants students’ the right to pay the same tuition and fee rates as Canadian Citizens.
1. A
I
PPLICATION
NFORMATION
U of M Student # (if known) |_ |
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U of M Applicant # (if known):
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Program Name
Program Start Date
2. P
I
3. M
A
ERSONAL
NFORMATION
AILING
DDRESS
Family Name/Surname
Post Office Box or Number and Street
First Name/Given Name
City or Town
Middle Name(s)
Province
Previous or Other Names
Postal Code
Country
(Surname)
Social Security Number
Date of Birth
Email
(required) YYYY/MM /DD
(required)
Place of Birth
Title
Home Telephone
(Province or Country)
(Mr., Miss, Ms., Mrs., Dr., Rev.)
Gender: Select one ()
Citizenship
Alternate Telephone
Male Female
4. C
/R
5. D
’
L
ITIZENSHIP
ESIDENCY
RIVER
S
ICENSE
Are you an American Citizen?
YES
NO
Do you have a Driver’s License?
YES
NO
If YES, please provide details:
If NO, What is your immigration status in the United States or your country of
citizenship?
State/Province of issue:
Date issued:_
License #:_
Are you currently residing in Minnesota?
YES
NO
If NO, answer the following:
Do you own a motor vehicle?
YES
NO
Current residence (state/province, country):
If Yes, please provide details:
Reason for residing outside of Minnesota:
_
State/Province of issue:
Date issued:_
Length of time spent residing outside of Minnesota:
Registration #:_
Have you filed a Minnesota State Tax Return?
YES
NO
If YES, in what year?
201