Student Contact Information

The information collected here will be used to contact students and/or their families in case of a campus or personal emergency, and to conduct College business. This information will be made accessible only to employees of the College. Please allow 2-3 business days for processing.

These emergency contacts will REPLACE all emergency contacts previously given to the College.


Student Contact Information

The Student ID Number, Student First Name, and Student Last Name must match the information on your Student ID or Orientation Folder exactly.

Student ID Number:*
Student First Name:*
Student Last Name:*
Primary Email Address:
Student Cell Phone: Ext: US International



Contact #1 - Required

Contact #1 First Name:
Contact #1 Last Name:
Contact #1 Relationship:
Contact #1 Email:
Contact #1 Cell Phone: Ext: US International
Contact #1 Home Phone: Ext: US International
Contact #1 Work Phone: Ext: US International



Contact #2

Contact #2 First Name:
Contact #2 Last Name:
Contact #2 Relationship:
Contact #2 Email:
Contact #2 Cell Phone: Ext: US International
Contact #2 Home Phone: Ext: US International
Contact #2 Work Phone: Ext: US International



Contact #3

Contact #3 First Name:
Contact #3 Last Name:
Contact #3 Relationship:
Contact #3 Email:
Contact #3 Cell Phone: Ext: US International
Contact #3 Home Phone: Ext: US International
Contact #3 Work Phone: Ext: US International






* Required fields





© 2004- Cottey College   •   1000 West Austin, Nevada, Missouri 64772   •   Phone: 417-667-8181   •   Fax: 417-667-8103