Jefferson Community College
Registration of Confidential Contact Information
Students residing in on-campus housing have the option to register a confidential contact person
who will
be notified in accordance with this policy if the Jefferson Community College Safety
and Security
Department, or local law enforcement dete1mines that the student is missing.
For purpose of this policy, the term "on-campus housing" means property that is owned,
maintained and/or
operated by FSA, the occupancy of which is governed by a contract with the
Office of Residential Life.
The confidential contact may be someone other than the emergency contact listed with the
Office of
Student Records. The student may register more than one confidential contact.
Only authorized campus officials and law enforcement officers pursuing the missing person
will have access to this information.
A student may register such confidential contact information at any time by filing a
Confidential Contact
form with the Safety and Security Department.
Each student who files a Confidential Contact Form is solely responsible for the accuracy of
the Contact
information by filing a new Confidential Contact Form with the appropriate
Student Name: ____________________________________
Student J Number: ________________________________________
Student Cell Phone: _________________________________
Student Email Address: ___________________________
I, , have received a Registration of Confidential Contact Form, I
designate the
following person to be my confidential contact:
Name: ______________________________________
Relationship: __________________________________
Address: ____________________________________
Home Phone: __________________________________
Cell Phone: _____________________________________
Alternate Phone: _______________________________
Email Address: _______________________________
Alternate Email Address:____________________________________
I understand the following:
If the Jefferson Community College Safety and Security Department determines that I
have been
missing for more than 24 hours, my confidential contact will be notified
within 24 hours of that
The College may notify my confidential contact within 24 hours of my disappearance if,
in the judgment of the Jefferson Community College Safety and Security Department, the
warrant earlier notification;
l 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 Pol icy and Procedure.