COVID-19 - USP LAUCALA Students Contact Database

Please complete the survey below. All information will be kept confidential and shall be used for the purpose of evacuation logistics if required.

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* 1. Name as shown on passport

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* 2. USP Student ID number

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* 3. Nationality as shown on current valid passport

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* 4. Phone Contact

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* 5. Alternative Phone Contact (Emergency)

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* 6. Current Physical Address

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* 7. Emergency contact details

Name *

Address *

City/Town

Country *

Email Address *

Phone Number *

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* 8. Country of Usual Residence

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* 9. Are you a private/sponsored student?

Private

Sponsored (please provide Sponsor's Name & Contact Details)