Microcredential Request Form

Use this form to request your Professional Microcredential.

(* denotes required field)

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Professional Microcredential Type*
Name* (as you want it to appear on the microcredential)
Full legal name*
Birth date* (dd/mm/yyyy)
Phone number*
Mailing address*
E-mail address*
Confirm e-mail address*

The University of Regina collects information under the authority of The University of Regina Act and in accordance with the Local Authority Freedom of Information and Protection of Privacy Act and the Personal Information Protection and Electronic Documents Act for purposes of the administration of the University and its programs and services. By responding to this form, you are consenting to the University of Regina using your personal information to fullfil your request.