Professional Documents
Culture Documents
Enrollment Number
01C36473 000-dabeniul-052
This amendment (“Amendment”) is entered into between the parties identified on the attached program
signature form. It amends the Enrollment or Agreement identified above. All terms used but not defined
in this Amendment will have the same meanings provided in that Enrollment or Agreement.
2. The Participant Form attached to the agreement as Exhibit 1 is amended to add the following
participant(s):
Participant
Name of Entity: Misericordia University
Participant Enrollment Details
Participant Enrollment Number (Microsoft to complete):
Prior Enrollment Number:
Faculty and Staff: 403
If Student Option selected, number of Students: 6400
Participant Contact Details
Street Address 301 Lake St Contact Name: David Johndrow
City Dallas State PA Zip 18612 Contact Email Address:
djohndrow@misericordia.edu
Country US Phone 570-674-6762
(Page 2 is not required but may be used to add additional participants. You may make and submit as many copies
of page 2 as are necessary.)
Participant
Name of Entity:
Participant Enrollment Details
Participant Enrollment Number (Microsoft to complete):
Participant
Name of Entity:
Participant Enrollment Details
Participant Enrollment Number (Microsoft to complete):
Prior Enrollment Number:
<Choose>:
If Student Option selected, number of Students:
Participant Contact Details
Street Address Contact Name:
City State Zip Contact Email Address:
Country Phone
Participant
Name of Entity:
Participant Enrollment Details
Participant Enrollment Number (Microsoft to complete):
Prior Enrollment Number:
<Choose>:
If Student Option selected, number of Students:
Participant Contact Details
Street Address Contact Name:
City State Zip Contact Email Address:
Country Phone
Except for changes made by this Amendment, the Enrollment or Agreement identified above remains
unchanged and in full force and effect. If there is any conflict between any provision in this Amendment
and any provision in the Enrollment or Agreement identified above, this Amendment shall control.