SIENA HEIGHTS UNIVERSITY SAFETY AWARENESS HANDBOOK
FORMS Confidential Missing Person Contact , please tear out , complete and return to Public Safety .
Siena Heights University Department of Public Safety
517-264-7800 - https :// www . sienaheights . edu / who-we-are / campus-safety /
CONFIDENTIAL MISSING PERSON NOTIFICATION
By completing this form , I am requesting Siena Heights University Department of Public Safety to notify the following individual should I become missing for over 24 hours . I understand that Siena Heights University Department of Public Safety will notify the appropriate law enforcement entity with jurisdiction ; this information may be shared with Law Enforcement Officers acting within their duties .
__________________________________________________________________________________________________________ STUDENT NAME Please print legibly
__________________________________________________________________________________________________________ NAME OF CONFIDENTIAL CONTACT Please print legibly and include all formal names and known nicknames
__________________________________________________________________________________________________________ PHONE NUMBERS OF CONFIDENTIAL CONTACT Include all possible numbers that are applicable ie cell , home , work …
__________________________________________________________________________________________________________ ELECTRONIC COMMUNICATION PREFERENCE Include IM , e-mail , and any other electronic medium
For students under the age of 18 years and not legally emancipated , Siena Heights University will also notify a custodial parent or guardian if the student is missing .
__________________________________________________________ ______________________________________________ Signature Date of Birth Date of Signature
Return this completed form to Public Safety located at the Welcome Center in Ledwidge Hall
Completing this form is voluntary . Information contained in this form is for Public Safety or Law Enforcement use only and only under the conditions outlined above . Public Safety will register and maintain this information confidentially .