International Emergency Contact Information

Please provide the following information so that the Center for International Education can contact you while abroad in the event of an emergency during the course of your study abroad term. This information will be used only in the event of a true emergency, and only if UMW is unable to contact you directly.

Name*
First Last
Banner ID*
UMW Email*
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)*
International Point of Contact*
This should be a person at your host university or program (such as the Director of your program, a study abroad coordinator, an international Exchange Officer, etc…) that UMW could contact abroad in the event of an emergency.
First Last
Point of Contact Affiliation with your Program
Job title, such as Director or Program Coordinator
Point of Contact Email*
Point of Contact (International) Phone*
Please list phone number as dialed from the US, including country code.
Point of Contact FAX
Please list fax number as dialed from the US, including country code.
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*
Number
Name
First Last

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