Privacy Notification - The State of California Information Practices Act of 1977, effective July 1, 1978, requires the University to provide information to individuals who are asked to supply information about themselves.
The principal purpose for requesting the information on this form is to contact the designated person in case of serious illness, accident or death. University policy authorizes maintenance of this information.
Other than name, furnishing the information requested on the form is voluntary. There is no penalty for not completing this form. Information furnished on this form may be used by various University departments for contacting relatives or a designated representative, filing for benefits and payment of benefits.
Individuals have the right to review their own records in accordance with Staff and Academic personnel policies and procedures.