Revised 7/12/2019
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Missing Student Contact Information Form
In accordance with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, 20 U.S.C. §
1092(f) (Clery Act), Collin College students residing in Collin College Student Housing located on the Plano Campus may
register one (1) or more individuals to be a missing person contact. If the student resident is
determined to be missing
by the Collin College Police Department or a local law enforcement agency, the student resident’s missing
person contact
or contacts will be notified by Collin College within 24 hours of the determination.
Student residents’ missing person contact information will be registered confidentially and accessible only to authorized
Collin College
officials. Additionally, this contact information will not be disclosed, except to law enforcement personnel who
are authorized to
access it during a missing person investigation. Student residents who choose to register one (1) or more
individuals to be a missing
person contact must complete this form. Student residents’ completed Missing Student Contact
Information Forms will be kept in the Dean of Students Office at the Collin Higher Education Center (CHEC).
Once you have filled out this entire form, place it in an envelope, seal the envelope, and print or type your name and College
Wide ID (CWID) number on the front of the envelope. Return the sealed envelope with your completed form to
the Collin
College Dean of Students Office in person at any campus.
CHEC: Room 457 Frisco Campus: Room F-127
McKinney Campus: Room B-336 Plano Campus: Room D-128
Student's Information
First Name: Middle Initial: Last Name:
9-Digit CWID Number:
Collin College Student Hous
ing
Apartment
Number:
Phone Number:
Collin College Email Address:
First Contact's Information
First Name: Last Name:
Phone
Number: Email Address:
Str
eet Address:
City: State:
Zip Code:
