Date:

First/Contact Name

Last Name (if applicable)

Department (if applicable)

Local/Campus address

Work Phone                     

Home/Cell Phone

E-mail Address

Choose one:

  Department/Office
  Student
  Faculty/Staff
  Community Participant    

If you have any questions, please contact:
Central Michigan University
Office of Multicultural Academic Student Services
108 Bovee University Center
Mt. Pleasant, Michigan 48859

 

Office phone: 989-774-3945
Office fax: 989-774-1376

Central Michigan University Office of Multicultural Academic Student Services 108 Bovee University Center Mt. Pleasant, Michigan 48859

 

 

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