International Emergency Contact Information - Center for International Education

International Emergency Contact Information Form

Name*
First Last
Banner ID*
UMW Email*
Personal/alternate Email
International Phone Number
If you have an international cell phone or VOIP phone, or have been given a number where you can be reached at a residence during your time abroad please provide it, including the country code.
Study Abroad Program or Host University*
Program Start Date (mm/dd/yyyy)*
Program End Date (mm/dd/yyyy)*
US Emergency Contact*
Whom should we contact in the event that we are notified of an emergency event during your time abroad? (Typically a family member).
First Last
US Contact Phone*
US Contact Email*
Relationship to You*