Missing Person Information

Fields marked with an * are required

As outlined in the 2008 Higher Education Opportunity Act, Clarke University must provide students an opportunity to submit the name of the person they want contacted in the event that the student is confirmed missing. This form must be separate from the emergency contact information requested on the Personal and Emergency Information (PEI) form. Please be aware that in order to confirm a person is missing, the individuals listed as emergency contacts on the PEI form will be contacted prior to notifying the below listed person.

Your Email Address *

First Name *

Middle Name *

Last Name *

Birthdate *

Cell Phone *

Detail of Person to Contact in Case you are confirmed Missing - all fields are required

Relationship *

First Name *

Last Name *

Daytime Phone *

Evening Phone *

Cell Phone *

Person's Email Address *

By submitting this form, you are giving permission to Clarke University to contact the person listed if you are confirmed missing *