Personal Data Document

The Personal Data Document provides the college with basic information concerning the sharing of records and academic, health, and billing information, as well as emergency contact information. It is mandatory that you complete this document.

Basic Information

The RAVE Broadcast System is used to notify all students, faculty, and staff of campus wide emergencies and notifications. This includes, but is not limited to campus closings, inclement weather, active shooter, campus wide announcements, and location changes for campus wide events. The RAVE system will send a text and/or email with information to all users. The information shared through the texts and emails will be brief and informative. All students are included in the RAVE system. For questions regarding the RAVE Broadcast System, contact the Office of Student Life. Once classes begin, we will do a test RAVE broadcast to ensure everyone receives the text and email.
Listed on Deposit Acknowledgment Letter and/or Financial Aid Award letter.

Emergency Contact Info and Relation to Student

Second Emergency Contact Info and Relation to Student

FERPA/Sharing of Information

Your grades and billing statement cannot be shared until the following is checked.
Eureka College is subject to the provisions of a federal law known as the Family Educational Rights and Privacy Act (FERPA), the federal law that governs release of and access to student education records. Release of this information is not done at Eureka College without the expressed, written consent of the student. For more information visit our FERPA documentation

Academic Report

Please check all that apply. If selecting Father, Mother, or Other, you will be prompted to provide their information before submitting the form.

Health Release

Please check all that apply. If selecting Father, Mother, or Other, you will be prompted to provide their information before submitting the form.

Financial Release

Please check all that apply. If selecting Father, Mother, or Other, you will be prompted to provide their information before submitting the form.

Photo Media Release

I grant Eureka College the unrestricted right to use and publish my name and my photo for editorial, trade, advertising, and any other purposes in any manner and medium; and to alter and composite the same with restriction and without my inspection or approval. I hereby release Eureka College, and any parties contracting with the institution, from all claims and liability relating to said photographs or media productions.

Student Handbook

As a student at Eureka College, I understand that I am responsible for knowing and abiding by the College regulations and procedures as outlined in the Student Handbook which is available on the main page of the Eureka College website, www.eureka.edu. I acknowledge that this information will be reviewed at orientation sessions (fall - Welcome Week/spring - New Student Orientation) along with being sent to all members of the campus community at the beginning of the fall and spring semesters via Eureka College email. The policies include, but are not limited to the following: Alcohol and Other Drug Policy Policies for Information Technology Academic Policies Residential Life Policies Judicial Policy and Procedures

Family Information

Required if student is under the age of 21. Please use spouse, relative, or guardian if parent information does not apply.

If you selected to share only with yourself, this page will not have any fields to complete. Please select Next to continue to the final step.

Fathers Information

Mothers Information

Others Information

Signature and Authorization

1

Basic Information

2

Emergency Contact

3

FERPA/Sharing of Information

4

Academic Report

5

Health Release

6

Financial Release

7

Photo Media Release

8

Student Handbook

9

Family Information

10

Signature and Authorization