Int'l Student Emergency Contact Form
I. General Biographical Information
Last Name: First Name: Middle/Father's Name: AUB ID Num: Gender: Male Female Date of Birth (d,m,y): Country of Citizenship: Country of Birth: Number of years spent at a highschool abroad: Undergraduate Graduate Special Student Visiting Summer Arabic Other Major
II. Local Address
Street Address: Building: Area: AUB Post Office Box Number: Local Phone Number: Mobile Number: E-mail:
III. Permanent Address in Home Country
Street Address: City or District: State or Province: Country: Zip Code: Telephone number: Country Code: City Code: Number:
IV. Emergency Contact Information
Please provide us with contact information for the person you would like us to reach in the event of an emergency. NAME: RELATIONSHIP TO YOU: Street Address: City or District: State or Province: Country: Zip Code: TELEPHONE: Home: Work: E-mail: In case of emergency, the university reserves the right to disclose information to parents, legal guardians, and other academic or university officials.
V. Immigration Information
Passport Information Country Issued By: Passport Number: Date Issued: Place Issued: Expiration Date: Visa/Residence Permit (RP) Information Visa Type or RP Number: Place Issued: Date Issued: Expiration Date: Single entry: Multiple entry:
