Address and Emergency Information

Please don't fill out this input box.

Required fields are marked with an asterisk (*).

First name*

Middle name

Last name*

What is your M number?*(aka BearPass Number)

Local Street Address*

City*

State*

Zip code

What is your cell phone number?*

Do you have a home phone number? If so, please write it here.

What is your MSU email address?*

Please list your native language(s).*

In case of emergency, who would you like us to contact?

What is his/her full name?*

What is his/her relationship to you?*

What is his/her address?*

What country does he/she live in?*

What is his/her phone number?*

What is his/her email address?*