Request Type I am reporting on my own status I am inquiring about someone else I am reporting status for multiple people Your given/First name Your family/Last name A telephone number where you can be reached Email address What is your status? Safe Injured & hospitalized Injured & not hospitalized Sheltering in place On campus What is your location? Assembly area Home Work Other Other (please describe) Would you like us to contact someone to let them know your status/location? Yes No Name of contact Phone number of contact Please provide a brief description of why you were involved in this incident The First Name of the Family Member or Friend you feel may be affected by this incident The Middle Initial of the Family Member or Friend The Last Name of the Family Member or Friend you feel may be affected by this incident Phone Number of the Family Member or Friend Citizenship of the Family Member or Friend US Citizen Non-US Citizen Country of Origin of the Family Member or Friend Please provide a brief description of why you believe this individual may be affected or involved in this incident I am the _______________ of the family member or friend What is your relationship to the family member or friend? Ex: I am the ___________ of the family member or friend...(Mother, Father, Brother, Sister, Aunt, Uncle, etc.) What are your current needs? Current location and names of group: I understand I am providing my contact information in order to receive updates and support services Math question 2 + 17 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. Leave this field blank