Name: ___________________________________ Department: ___________
Address: ____________________________________________________________
City: __________________________ Street ________ Zip ___________
Phone (day): _____________________ (evening): ______________________
E-mail: _____________________________________________________________
Please specify if you want an on-campus orientation, or a telephone orientation:
_____________________________________________________________
NOTE: For telephone orientations, please allow 4 to 5 days to allow materials to be delivered via USPS.
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Submit by mail to: Office of Curriculum Development & Support
1145 King Road L-213
Immaculata, PA 19345-0664
Or submit electronically to: Fax: 610-251-1668 E-mail: vshay@immaculata.edu Phone: 610-647-4400 ext. 3062, 3153 or 3033
For internal use only:
CANON: Please deliver to Lourdes, Room 213. Thank you!