BIO Department Update Form

This form will be used for internal BIO office business only. Cell phone and other private info will not be shared, unless you give permission for this info to be shared.

It is used for emergency purposes as well as when booking flights, arranging travel, conference registration, etc.,

Name Name * First Last
Home Address Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Home Phone or Cell Phone Your Home Phone or Cell Phone * - ### - ### ####
Your Alternate Phone Your Alternate Phone - ### - ### ####

Another phone number where we might be able to reach you if needed.
What is your office Room Number?
(Please list the office that you will be in next semester.) *
Do you have a phone in your office? *

Do you have a phone in your office? Yes No
Office Phone Number Office Phone Number - ### - ### ####
Do you have voice mail in your office phone? *

Do you have voice mail in your office phone? Yes No I don't know N/A
Do you WANT voice mail in your office? *

Do you WANT voice mail in your office? Yes No N/A
If you will not to have an office phone, is there another number that you would like to have available in the EIU directory for students, faculty, staff and others to contact you? If so, enter that number here or type - No.
Your date of birth Your date of birth * / MM / DD YYYY

This is always needed when making flight reservations and for other purposes of office use.
Is it ok to share the info above with others in the department? (Not the year, just the day.) *

Is it ok to share the info above with others in the department? (Not the year, just the day.) Yes No
Is it ok to share these phone numbers with others in the department? *

Is it ok to share these phone numbers with others in the department? Yes No

If you chose not to share your phone number, it will be used only for departmental use and available only to Canam, Britto, and Marschelle.
What is the room number of your primary lab space?
If you have more than one room being used for lab space, please also list that room number(s) here
Which graduate student(s) do you mentor? *

If non, just type 'N/A'
Need to Update Your Faculty Research Blurb? Please enter the info here.

This is to update the faculty research interests that is provided to the public on th EIU website.
Which clubs or RSOs do you mentor or advise?
The information in this section is for emergency use only and will not be shared with others. The information is saved in a private server viewable only by Tom, Britto, and Marschelle.

It is actually much needed and has been used for emergency issues in the past.
Name of your spouse, significant other, or an emergency contact person. Name of your spouse, significant other, or an emergency contact person. * First Last
Relation to you *
Address of your spouse, significant other or emergency contact person, if different from yours Address of your spouse, significant other or emergency contact person, if different from yours
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone of your spouse, significant other or emergency contact Cell Phone of your spouse, significant other or emergency contact * - ### - ### ####
Landline or alternate phone Landline or alternate phone - ### - ### ####
Spouse/Emergency Contact's Employer (for use only in case of emergency)
Spouse/Emergency Contact's Work Phone (for use only in case of emergency) Spouse/Emergency Contact's Work Phone (for use only in case of emergency) - ### - ### ####