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Austin Community College
9101 Tuscany Way
Austin, Texas 78754

Emergency Contact Information

Form Purpose: Because of the Health Insurance Portability and Accountability Act (HIPAA), which protects health patient privacy, emergency contact information and permission to release information is required from you, the student. This information will only be used in the event of serious injury or death. Please provide a contact person who can make important medical decisions for you, if you are unable to do so for yourself.
Format: PDF (fillable and printable from this web site)
Administrative Rule and/or Procedures: Record Series JC 3700-01. Student Record.
Access:Available for public viewing

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