Missing Student Policy And Procedure Emergency Contact Form

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Wenatchee Valley College
Missing Student Policy and Procedure
Emergency Contact Form
In compliance with the Missing Student Procedures 20 USC 1092 (j) (Section 488 of the
Higher
Education Opportunity Act of
2008), it is the policy of Wenatchee Valley College to investigate any
report of a missing student who resides on-campus.
Each student living in an on-campus student housing facility has the option to identify an individual to
be contacted by the college and register confidential contact information in the event that the student
is determined to be missing for a period of more than 24 hours. Only authorized campus officials and
law enforcement officers in furtherance of a missing person investigation may have access to this
information.
If the resident student is under 18 years of age, and not an emancipated individual, you must
complete this form and your emergency contact must be a custodial parent or guardian.
 New information
 Updated/Corrected Information
Please print legibly
Student’s Name: _______________________________________________________________
Student’s SID #: ___________________________ Date of Birth: ________________________
Campus Housing Assignment: ____________________________________________________
IN CASE OF EMERGENCY
Contact: ______________________________
2nd Contact: _____________________________
Address: _____________________________
Address: ________________________________
City, State, Zip: ________________________
City, State, Zip: ___________________________
Home Phone:__________________________
Home Phone: ____________________________
Work Phone: __________________________
Work Phone: _____________________________
Cell Phone: ___________________________
Cell Phone: ______________________________
E-mail Address: ________________________
E-mail Address: ___________________________
Attention: If your emergency contact information changes, complete a new emergency contact form and
submit it to the residence life coordinator.
________ I do not wish to identify an emergency contact person in accordance with the missing
student notification policy and procedure.
I have read the Wenatchee Valley College missing student policy and procedure and understand that
the individual(s) listed above will be contacted should I be deemed missing for more than 24 hours. I
understand I am solely responsible for the accuracy of the information of my confidential contact and for
updating this information as needed.
Signed: ____________________________________
Date: ______________________
10/17/11 tm

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