Emergency Contact Information for Internationals

Name*
First Last
Your E-mail address*
Primary Emergency Contact Name*

The primary emergency contact name should be the person you would like UMW to contact in case of an emergency.
Contact's Relationship to You*
- Parent
- Spouse
- Other
Does your contact speak English?*
- Yes
- No (If no, plese consider entering a contact name who does speak English.)
Primary Emergency Contact's Phone Number*
Primary Emergency Contact's E-mail*
Primary Emergency Contact's Address