Missing Person Confidential Contact Form
Student Name: _____________________________
Student ID Number: ___________________
Cell Phone: __________________________
Email Address: __________________________________
I have received and reviewed a copy of the Missing Student Notification Policy and Procedure.
In accordance with that policy, I designate the following person to be my confidential contact:
Name: ______________________________ Relationship: ________________
Address: _________________________________________________________________
Home Phone: _____________________ Cell Phone: ____________________
Email Address: _____________________________________________________________
Alternate E-mail: ____________________________________________________________
I understand the following:
- If the Piedmont College Campus Police Department determines that I have been missing for more than 24 hours, my confidential contact will be notified within 24 hours of that determination;
- The College may notify my confidential contact within 24 hours of my disappearance if, in the judgment of the Protective Services, the circumstances warrant earlier notification;
- I am solely responsible for the accuracy of the information provided on this form and for providing updated information as necessary;
- Additional information about the College’s policies and practices are contained in the Missing Person Notification Policy and Procedure.
Signature: _________________________________ Date: _____________