New & Transfer Student Orientation

Wednesday, August 21-Sunday, August 25

All new students are required to participate in the orientation program. Registration must be completed by Friday, August 9. This form will be reviewed by the Office of Student Affairs prior to orientation.

Questions?

Contact Ruben Henao, Associate Director of Student Affairs and Residence Life, at studentactivities@chatham.edu or at 412-365-1281

First Name :
Last Name :
Email :

Emergency Contacts & Parent/Guardian Contact Information

Certain health/medical information must be made known to the instructor(s) conducting programs, so that they can be prepared to respond appropriately. This information will be held in confidence.

*We will also use these contacts to inform your parents/guardians of Chatham Family & Friends Association membership, family and friends newsletters & activities.

Primary Contact
Full Name :
Relationship :
Address :
City :
State :
Zip :
Phone :
Email :

Secondary Contact
Full Name :
Relationship :
Address :
City :
State :
Zip :
Phone :
Email :

	Do you have any allergies? (If yes, please list below)

	Do you have any chronic conditions (asthma, diabetes, etc)? (If yes, please list below)

	Are you taking any medications? (If yes, please list and indicate dosage and interval taken below)

Name any limiting physical and/or emotional disabilities or illnesses not already mentioned.

Religious Affiliation (OPTIONAL):
By selecting an religious affiliation you are granting Chatham University permission to release your contact information to members of the Chatham Multi-Faith Council.

Other :