Professional Certificate Request Form

Use this form to request your printed non-credit certificate.

Certificates are printed in February and September.

Deadline for February printing: February 15
Deadline for September printing: September 15

(* denotes required field)

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Certificate type*
Location*
Name* (as you want it to appear on the certificate)
Full legal name*
Birth date* (dd/mm/yyyy)
Phone number*
Mailing address*
City*
Province*
Postal code*
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/for ...describe specific purpose of information gathering on this form).