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Campus Emergency - Student Tracker
Please provide identifying information below as well as contact information where you can be reached during this emergency. Optionally, you can enter email addresses for parents or others that you would like to receive a copy of this information.
Identifying Information
Dawg Tag Number:
*
First Name:
*
Last Name:
*
Date of Birth:
*
Email Address:
Home Town:
*
Indicates a required field
Contact Information
Cell phone or best number to reach you:
-
-
Alternate phone number to reach you:
-
-
Other emergency or family phone number:
-
-
Address where you will be staying:
Email addresses to which automatic notification should be sent:
(comma separated)
Comments or Messages:
By submitting this form, I confirm that I am the person identified above and hereby give my permission to Southern Illinois University Carbondale to release this information at their discretion.
