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Emergency Contacts

In the event of an emergency, we may need to contact a family member or friend on your behalf.  To comply with FERPA (Family Educational Rights and Privacy Act), we are required to have you designate the people we may contact.

 

All students are required to supply at least one emergency contact person before beginning classes.

 

 

 
Student Information
* First Name:
* Last Name:
* PID: 
* Columbia Email:
* Home Phone:
Work Phone:
Mobile Phone:
* Mailing Address:
* City, State, Zip

 

 
Emergency Contant Information:

 
Contact #1
* Title:
* First Name:
* Last Name:
* Relationship to you (parent, spouse, partner, friend, etc):
* Home Phone:
Mobile Phone:
Work Phone:
* Email:

 

 
Contact #2
Title:
First Name:
Last Name:
Relationship to you (parent, spouse, partner, friend, etc.)
Home Phone:
Mobile Phone:
Work Phone:
Email:
Notes:
* Indicates Response Required