Contact Details Form

Yes

Uni ID

User code

Full name

Preferred Name

Contact Address and Postcode

Contact Telephone Number

Home address and Postcode

Home Phone Number

Name of Placement Provider

Address of Placement Provider

Your Placement Contact Name

Placement Contact Telephone Number

Placement Contact email address

Emergency Contact Name

Relationship with Emergency Contact

Emergency Contact address and postcode

Emergency Contact telephone number

Remarks

Privacy notice

The data on this form will be stored and used as contact information in relation to your intercalated year. By completing this form you agree that the department is able to contact you, your placement provider and if necessary your emergency contact during your intercalated year

We will not use the data for any other purpose.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

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Contact Details Form

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