Uh-oh! JavaScript is either disabled or not supported by your browser. Please enable JavaScript on your browser or upgrade to a JavaScript-capable browser to use Cal State East Bay web forms.

Emergency Contact
Human Resources

NetID

First name Required

Middle name

Last name Required

Emergency Contact Information

Relationship Required

First name Required

Middle name

Last name Required

Phone Required (home) (enter 0000000000 if not applicable)

Phone Required (mobile)

Phone (business)

Address Required

Apt / Suite / Other (optional)

Unit #

City

State

ZIP Code

Emergency ContactHuman Resources

Emergency Contact Information

Emergency Contact
Human Resources