E-Check-in Fall 2015
Thank you for your participation in our E-checkin process. This form must be completed on or before August 30th, 2015

This form will collect your contact information, along with your emergency contact information.

Important Note: Information will be used on an as-needed basis only. Cell phone numbers and emergency contacts will not be shared publicly. The Residential Life staff relies on PSU email as a primary method of communication. Please check your PSU email regularly.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Cell Phone Number (with area code) *
Use format (603)123-4567
Residential Area/Building
Clear selection
Room/Apartment number
Vehicle Make, Model and Color
Example: Ford Fusion Red
Vehicle License Plate (State)(Number)
We use this information in case of snow or flood emergency
Emergency Contact name and realtionship to you *
Joe Smith- Father
Emergency Contact Phone Number *
Use format (603)123-4567
Emergency Contact #2 name and relationship to you
Sue Smith- Mother
Emergency Contact #2 Phone Number
Use format (603)123-4567
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Plymouth State University. Report Abuse
Google Forms