Emergency Contact  ·  Recommended

Collect Residence Hall Emergency & Missing Person Contacts

Let campus housing residents register emergency and confidential missing person contacts in one form with built-in HEOA notification language.

Terra theme
formbuilder.ai/f/college-residence-hall-student-emergency-contact-missing-person-notification-form
College Residence Hall Student Emergency Contact & Missing Person Notification Form
Student Full Name
· · ·
Student ID Number
· · ·
University Email Address
· · ·
Submit

The College Residence Hall Student Emergency Contact & Missing Person Notification Form gives housing offices a simple, reliable way to gather critical contact details before an emergency happens. Students provide their full name, student ID number, university email, mobile phone, residence hall, and room number. They then list a primary emergency contact with relationship, phone, and email, plus a secondary contact as a backup.

A dedicated missing person notification section is written around the federal Higher Education Opportunity Act. It explains that campus residents may register a confidential contact to be notified within 24 hours if they are determined to be missing. It also states that local law enforcement will be notified regardless of their choice, and that confidential contact details are accessible only to authorized campus officials and may be disclosed only to law enforcement during a missing person investigation. Students indicate whether they are under 18 and not an emancipated minor, in which case a custodial parent or guardian will also be notified. They then choose who should be confidentially contacted and add a separate confidential contact if needed.

This template is designed for residence life departments, campus housing administrators, student affairs teams, and public safety offices at colleges and universities. It replaces paper cards and scattered spreadsheets with organized, searchable submissions. Share it during move-in, housing check-in, or at the start of each semester, and customize the fields, wording, and branding to match your institution's policies. Keeping accurate, up-to-date contacts on file helps your staff respond quickly and confidently whenever a student's safety is in question.

3 Pages
19 Questions
~6min To complete
Free Included on every plan
Field types Full Name ×4 Phone ×4 Dropdown ×3 Short Text ×2 Email ×2 Yes / No Single Choice termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Student Information 6 questions
Student Information
1 Student Full Name * Full Name
2 Student ID Number * Short Text
3 University Email Address * Email
4 Mobile Phone Number * Phone
5 Residence Hall * Dropdown
6 Room Number * Short Text
Page 2 Emergency Contacts 6 questions
Emergency Contacts
1 Primary Emergency Contact Name * Full Name
2 Primary Contact Relationship to Student * Dropdown
3 Primary Contact Phone Number * Phone
4 Primary Contact Email Address Email
5 Secondary Emergency Contact Name Full Name
6 Secondary Contact Phone Number Phone
Page 3 Missing Person Notification & Acknowledgment 7 questions
Missing Person Notification & Acknowledgment
As a resident of campus housing, you have the option under the federal Higher Education Opportunity Act to register a confidential contact. The university will notify this person within 24 hours if you are determined to be missing. This person may be the same as your emergency contact. Confidential contact information is accessible only to authorized campus officials. It may be disclosed only to law enforcement in furtherance of a missing person investigation. Whatever you choose, the university will notify local law enforcement within 24 hours. If you are under 18 and not an emancipated minor, your custodial parent or guardian will also be notified.
1 Are you under 18 years of age and not an emancipated minor? * Yes / No
2 Who should be confidentially notified if you are determined to be missing? * Single Choice
3 Confidential Contact Full Name (if different from primary contact) Full Name
4 Confidential Contact Relationship to Student Dropdown
5 Confidential Contact Phone Number Phone
6 I have read and understand the missing person notification information above. I certify that all information I have provided is accurate and complete. I agree to submit an updated form if any of my contact information changes. * termsandconditions
7 Student Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.

  • Ready-to-use structure — pre-configured fields out of the box
  • Applied "Terra" theme — fonts, colors, and layout already set
  • Mobile-responsive — works on every device without extra configuration
  • Fully editable with drag-and-drop — change anything in seconds
  • Included on every plan — try it free for 7 days

Use this template

Included on every plan. Open in the editor, customize, and publish in minutes.

Use This Template Free Preview the form
Category Contact & Inquiry
Subcategory Emergency Contact
Theme Terra
Badge Recommended
Price Free
Coding required None

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