The University of Winnipeg, Faculty of Theology

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					Priority ________                              The University of Winnipeg
                                         REGULAR Student REGISTRATION FORM
                              See reverse of this form for pertinent registration information. PRINT clearly in black.

Name (Last/first):_____________________________________________ Previous Name (if applicable):__________________________
Student Number_____________________               Birth Date: month ____ day___ year______                   Gender:    Male  Female
Citizenship:    Canadian Citizen      Landed Immigrant         
                                                                International Student from Country: _________________
1. If you are an international student have you submitted a copy of your Study Permit?  YES  NO If NO, please attach a copy to this form.

E-Mail: __________________________________Phone (home): (______)_____________                         Phone (work): (______)______________

Current Personal Address:_______________________________________________________________________________________
                          Street,                           City,                                   Province/State
           Canadian Postal Code: ___________               Fax Number: ________________________
2. Are you a SPONSORED STUDENT (someone else is paying your fees) ? NO      YES
If Yes, Name of Sponsor ____________________________________________________________________________
3. Have you been ABSENT from the University of Winnipeg MMFT program for more than three years?               NO         YES
Note: If YES, an Application for Continuance must be filled out, submitted, and approved by the MMFT Program Director before further registrations can be
 TERM              COURSE #              COURSE TITLE                                                                DATES              TIMES

It is the student's responsibility to become familiar with the University's and the MMFT program’s academic regulations and policies regarding
fees and/or withdrawal procedures as specified in the current calendar. See reverse of this form for pertinent registration information.

I hereby agree to honour all financial and academic obligations in accordance with the University of Winnipeg policies and have read the
Freedom of Information and Protection of Privacy Act (FIPPA) statement on the back of this form.

__________________________________                                                              ________________________________
Signature of Student                                                                                      Date

_________________________________                                                               ________________________________
Dr. Mary Warmbrod,                                                                                        Date
Program Director,

   The University of Winnipeg / Graduate Studies - Student Services / 515 Portage Ave / Wpg., MB, R3B 2E9
For Office Use Only:

                                                                                             Date Entered:                         Initials:

Revised 15 June 2012
                                                    Registration Information
Registration Dates:
Registration dates for Regular Students (which includes Occasional) are July 3 to August 31 for Fall and Winter courses of the
coming Academic Year. To learn Registration dates for Spring courses check the MMFT Program Brochure.
Registration Form and Procedures:
1. Please read the whole form first. Use a black ink to answer the questions.
2. Identify what priority level you are and enter that number with large print in the left hand corner.
                                                                 Priority Levels:
                                                     1. In or accepted into 4 practicum
                                                     2. In or accepted into 3 practicum
                                                     3. In or accepted into 2 practicum
                                                     4. In or accepted into 1 practicum
                                           5. Continuing Regular Student not yet in a practicum
                                                         6. First year Regular Student
3. Print the identification information requested. Note that if you have been absent from the program for more than three years you
      need to contact Dr. Mary Warmbrod, 786-9156, to seek an application for continuance.
4. Identify the Program Level you are.
      If you have never been in a practicum you are in the Theory Certificate level.
      If you are in the first practicum you are in the Therapy Certificate level.
      If you have passed the first practicum you are in the Master’s Degree level.
5. Record the Term, Course Number, Course Title, Dates & Times you have selected.
6. Sign the form and submit to the Program Director Dr. Mary Warmbrod by one of the following means:
      a. In person, 2S08, Aurora Family Therapy Centre
      b. In her mailbox, 2S04, Aurora Family Therapy Centre
      c. Fax: 204-772-2547 Attn: Mary Warmbrod
      d. Email signed and scanned form to with Subject line: Registration Form from (your name)
      e. Mail to Aurora Family Therapy Centre, University of Winnipeg, 515 Portage Ave., Wpg, MB R3B 2E9
7. Dr. Warmbrod will sign and organize all Regular Applications by Priority Level (with earlier dates first within each priority level) to
    submit to Eric Benson on the third day of Undeclared Registration dates. He will enter registrations by Priority Level starting with
    number 1. Regular Applications received after that date will be signed and forwarded to Eric Benson immediately.
8. Please check WebAdvisor for confirmation of Registration in courses, what your fees will be and when they are due. Fee
    statements are not mailed out via hard copy. It is the responsibility of the student to view WebAdvisor for all fees that are
    outstanding as well as applicable due dates. Fees not paid by due dates will be subject to applicable late fees. Please contact
    Grad Studies – Student Services if you have any questions.
9. Please remember that if you decide to withdraw from a course you must submit a Withdrawal Form to Dr. Warmbrod for her
    signature so it can be submitted to Grad Studies-Student Services for official withdrawal.

Personal information collected on this form will be utilized by the University of Winnipeg for registration purposes. It is collected
under the general authority of The University of Winnipeg Act, in conformity with, and protected under, the Manitoba Freedom of
Information and Protection of Privacy Act. The information will be used to register you in classes and record your grades, create
your permanent student record, and to provide you with student privileges (library, athletics, voting in elections, counselling and
health services). It will also be used for accounting and correspondence purposes related to registration, and may be employed in
the determination of eligibility for student awards. Information regarding graduation and awards may be made public. Elements of
your personal information may also be provided to University Advancement Services/University of Winnipeg Foundation to inform
you of University and community events, and for alumni contact purposes. Finally, personal information may be used to conduct
research into university enrolment and related statistical profiling activities. Your personal information is protected under the
Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection and the use of this
information please contact:

Mr Colin Russell,
                                                                         Ms Gabrielle Prefontaine,
                                                                         University Archivist and F.I.P.P.A. Coordinator,
The University of Winnipeg,
                                                                         The University of Winnipeg,
515 Portage Avenue, Winnipeg, Mb. R3B 2E9
                                                                         515 Portage Avenue, Winnipeg, Mb. R3B 2E9

Revised 15 June 2012

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