All full and part-time students must complete this form annually. The college will use the "Your Contact Information" section to contact you in the event of an on-campus emergency and for any event concerning delay or cancellation of classes. This information will also be listed in our registration database which your instructors will be able to access. All fields on this form are required. If a field is non-applicable, please write NA next to that field.

The College will only use the information provided in the Emergency Contact #1 and #2 sections in the event that there is an emergency situation concerning you personally. Please list the name, address, telephone number and email address of at least two people we may contact in case of an emergency for these purposes. You may use this form to update your current information at any time.

Please sign this form by typing your name and the date below.  By clicking "Submit", you are stating that all information contained in this form is complete, factually correct, and honestly presented.

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