Study Abroad Provider Emergency Contact Information Form

Please provide the following information so that the Center for International Education can contact you in the event of an emergency.

Study Abroad Program Name
Please provide the name of your program or university.
Program Country*
Please provide the country or countries where your program is located.
Program Location City*
Please provide the city or cities where your program is located.
Emergency 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 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.
Alternate Emergency Point of Contact
Please list phone as dialed from the U.S., including country code.
First Last
Alternate Emergency Point of Contact E-mail
Alternate Emergency Point of Contact Phone
Please list phone number as dialed from the US, including country code.
U.S. Office
If your program has a U.S. based office, please provide the name of the office here.
US Contact Phone
US Contact Email
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