506 North Guignard Drive | Sumter, SC 29150-2468 | 803.778.1961 | www.cctech.edu
Serving Clarendon, Kershaw, Lee and Sumter Counties
Please print clearly.
Employee ID: Employee Name (Last, First, MI)
________________________ ____________________________________________
Telephone:
( )
-
Cellular number for TEXT alerts*
*CCTC not responsible for potential data rates
( )
-
Type (Check One) Landline Mobile
( )
-
Type (Check One) Landline Mobile
Email:
@
@
@
I hereby authorize Central Carolina Technical College to send emergency notifications to the telephone
number(s) and / or email address(es) I listed above. I understand that I may change this information at any
time, but must do so by submitting this form again.
Employee Signature: Date:
_____________________________________ ________________________
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