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Mission College
Staff Login
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emergencyEvacInfo
Emergency Evacuation Information
Fields marked with
are required.
You
Full Name
College ID
Your Contact Information
Home Phone
Work Phone
Address Line
City
Zip
Mission College Counselor/Advisor
Ambulatory?
Be sure to update any changes with DSPS
Ambulatory?
Yes
No
A bit more about you
What mode of transportation do you normally use to attend school?
VTA Bus
VTA Access
Taxi/Ride Share
Other
Do you need assistance during an emergency?
Yes
No
List two emergency contacts
If you are a wheelchair user, please label your wheelchair with identification information. The information on this form will be shared only with the appropriate personnel on a need to know basis.
Signature (type your name)
(By signing, you agree to the
Terms of Service
)
Submit
You can submit only if required fields are filled