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Username: minimum 6 characters
Password: minimum 8 characters, must contain a number and any two of the following three: upper case, lower case, special characters (for example: (){}!@$%^&*)
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Preferred Name (If different from first name)
Former (maiden) Last Name

Primary Address
 
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Secondary Address

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Additional phone
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Education Level*
Birthdate*
Race/Ethnicity
Immigration Status*
Country of Citizenship

Country where the Learner has citizenship
Is English your first Language*
Yes No
*Country of Birth

Country where the Learner was born
Employer*
Company Type*
Are you a graduate of the University of Manitoba? (Alumni)
Yes No
University of Manitoba Degree Achieved
I would like to apply for the University of Manitoba Alumni Benefit
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Eligibility Requirements
Subject and course number for discount
Mail preference
May we include you on our email list?*
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