SOP - Student Information 2024-2025

Please provide the information requested below. This information is used by the Office of Student Affairs to contact you and identifies who we should in case of an emergency.

Name Name * First Middle Last
Date Date * / MM / DD YYYY
UIN - If you do not have a UIN yet, please input "0" for UIN. *
Local Phone Local Phone * - ### - ### ####
Cell Phone Cell Phone * - ### - ### ####
Email *
Local Address Local Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Permanent Address Permanent Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency Contact Information
Name Name * First Last
Relationship *
Email *
Cell Phone Cell Phone * - ### - ### ####
Home Phone Home Phone * - ### - ### ####
Parent Contact Information
Name Name * First Last
Phone Number Phone Number * - ### - ### ####
City *
State *
Zip *
I prefer *

I prefer regular meals vegetarian meals Other Other
Other meal-related information (e.g., cannot eat red meat, cannot eat pork, allergic to peanuts)
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

SOP - Student Information 2024-2025

SOP - Student Information 2024-2025

Emergency Contact Information

Parent Contact Information