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Community Member Emergency Contact Information

Please fill out the form and submit. This information will be used to contact you in case of emergency such as a campus closure announcement due to adverse weather or Pandemic flu outbreak.

If you are a student, staff, or faculty of UCC, please use the form within UCCLife.


NOTE: Fields with an asterisk (*) are required.

*First Name:
*Last Name:
Gender:

  

Status:
*Home Phone:
  (555) 555-5555 format
Work Phone:
  (555) 555-5555 format
Mobile Phone:
  (555) 555-5555 format
Text Messaging enabled Phone:
(Standard texting rates may apply.)
  (555) 555-5555 format
Email Address:
Removal Request:
 Yes, please remove my account from the emergency notification list.

  

                                    

 

 

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