Emergency contacts form - Venice International University

Globalization Program | Emergency Contacts

What defines an Emergency

-Serious injury, assault, or hospitalization
-Psychological problems
-Death or disappearance of a student
-Arrest or questioning by police
-Serious illness or death of a close relative

Student data

(*) required

First Name(s)(*)

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Last Name(*)

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University or Exchange student at(*)

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Phone number

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if available

Email(*)

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Contact Person (next-of-kin) in case of an Emergency

(*) required

First Name(s)(*)

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Last Name(*)

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Address(*)

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Phone number(*)

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e-mail address(*)

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Relationship with the student(*)

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Please provide some info on your travel to reach VIU

(*) required

Carrier/flight number(*)

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other Carrier/flight number

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if used

Airport hub for changeover(*)

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Scan of health insurance policy(*)

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please upload the scan copy of your insurance policy (pages where there is the insurance number and the period and countries of validity)

Privacy

I agree to allow Venice International University to use my personal data for administrative purposes or services provided by the University ( Italian and European Union law - D.lgs 196/03 and GDRP 679/2016)

I agree(*)

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Type the characters you're seeing in the picture above(*)

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Venice
International
University

Isola di San Servolo
30133 Venice,
Italy

-
phone: +39 041 2719511
fax:+39 041 2719510
email: viu@univiu.org

VAT: 02928970272