2012 Student Success Summer Program Application

(Use correct capitalization & punctuation when filling out this form)

PAYMENT INFORMATION - Program Fee is $250

Please send check to:

Concordia University - Student Success
Attn: Pam Schwartz - Student Life Ofc.
4090 Geddes Rd.
Ann Arbor, MI 48105

Or call 734-995-7310 to make credit card payment or arrange payment plan

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