Student Emergency form - Erskine College

Student's Name*

First Last

Erskine ID Number

Residence Hall & Room Number

Date of Birth*

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Telephone Number

Cell Phone Number*

Cell Phone Provider*

Father's/Guardian's Name*

First Last

If not applicable type N/A in both fields

Cell Phone Number*

Place Of Employment

Business Telephone

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Father's Email Address*

Mother's/Guardian's Name*

First Last

If not applicable type N/A in both fields

Cell Phone Number*

Place Of Employment

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Telephone

Mother's Email Address*

Emergency Contact*

First Last

This person must be someone other than your parent/guardian.(i.e. grandparent or neighbor)

Relationship*

Home Telephone*

Cell Phone Number*

Business Telephone

Secondary Emergency Contact*

First Last

This person must be someone other than your parent/guardian.(i.e. grandparent or neighbor)

Relationship*

Home Telephone*

Cell Phone Number*

Business Phone

Existing Medical Conditions*

If none please type "none"

Medications*

If none please type "none"

Allergies*

If none please type "none"

Health Insurance Company Name*

While the student Medical Fee provides students with access to campus health and counseling services, Erskine expects students to maintain independent, valid medical insurance coverage, usually secured under their parents’ medical insurance policy. Students who do not have medical insurance are encouraged to obtain coverage to address any medical costs in the event of illness, an accident, or other medical situation. Students may visit the Erskine Human Resources Office in Belk Hall for guidance on companies who write student medical insurance policies.

Policyholder's Name*

First Last

Contract/Policy Number*

Group Number

Missing Student Policy

Erskine College requests that all new students annually provide contact information in the event that the student would be reported officially missing during his or her tenure at Erskine. If a student is suspected to be missing from the campus, immediately contact the Office of Student Development at (864) 379-8701. All reports of missing persons made to the Office of Student Development are followed up with an on-going investigation. If it is determined by the Office of Student Development, in conjunction with Erskine Police, that a student for whom a missing person report has been filed has been missing for more than 24 hours, then within the next 24 hours Erskine will: Notify the individual identified by the student as the missing person contact; if the student is under 18 years old, the college will notify a parent or guardian, and; in cases where the student is over 18 and has designated another primary contact, the college will notify the appropriate individual; Erskine College Police Department will contact 911 to send out a missing persons alert. In accordance with federal regulations, Erskine College is required to provide students the opportunity to provide contact information for individuals regarding missing person investigations. Please provide the information for an individual you wish to be contacted if it is determined you are missing. This information will remain confidential and will only be used in a missing person investigation. To update this information, please contact the Office of Student Development at (864) 379-8701.

Contact Name*

First Last

Relationship To Student*

Phone Number*

CAPTCHA

Student Emergency Information

Missing Student Policy