Confidential Contacts

Every CSB/SJU student, eighteen (18) years of age or older, has the option to identify an individual to be contacted by CSB Security or SJU Life Safety Services not later than twenty-four (24) hours after circumstances indicate that he/she may be determined to be missing. For each student who is under age eighteen (18) and not emancipated, the institution is required to notify the custodial parent(s) or legal guardian(s) not later than twenty-four (24) hours after the time at the student may be determined missing.

Confidential Contact information is information pertaining to a person designated by the student as his/her "Confidential Contact" in addition to emergency contact information provided during orientation, registration, or other related purpose. In cases where a Confidential Contact is not designated, or the Confidential Contact cannot be reached at the number provided by the student, the emergency contact previously provided to the college/university will be used. The emergency contact may be notified in addition to any Confidential Contact designated.

Students, eighteen (18) years of age or older, may register a person designated as a Confidential Contact at any time using this form. The student providing this information is solely responsible for the accuracy of the information as well as any update of information regarding the Confidential Contact.

REGISTER CONFIDENTIAL CONTACT INFORMATION

STUDENT'S NAME (First, Middle, Last):

STUDENT'S DATE OF BIRTH (mm/dd/yyyy):

STUDENT'S ID (BANNER) NUMBER:

my CONFIDENTIAL CONTACT'S name is:

Relationship (sibling, parent, friend, priest/minister, professor, etc):

my CONFIDENTIAL CONTACT'S home phone number is:

my CONFIDENTIAL CONTACT'S cell phone number is:

my CONFIDENTIAL CONTACT'S e-mail address is:

my CONFIDENTIAL CONTACT'S alternate number is:

I hereby certify that I (check all that apply):

	am 18 years of age or older.
	am under 18 and not emancipated.
	am an emancipated juvenile (under 18).
	am a currently registered CSB/SJU/SJP student.
	reside in on-campus housing (dorm/apartment).
	reside in college/university owned, off-campus housing.
	reside in privately owned, off-campus housing.

Please review the information you are submitting to ensure its accuracy. When finished, click the <SUBMIT> button.

Leave this blank, it's here to thwart SPAM bots.