Personal Information and Emergency Contact Form - UT System: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the MEMBER INFORMATION section. Enter your Last Name, First Name, and Employee ID/Benefits ID (BID). Ensure accuracy as this information is crucial for identification.
Continue with your address details. Fill in your Street Address, Apt., Floor, Unit, City, State, and Zip Code. This ensures that your contact information is up-to-date.
Provide your Home Phone and Cell Phone numbers in the specified format (XXX) XXX-XXXX. Additionally, enter your Email Address for electronic communication.
Indicate whether you would like to be contacted by email by selecting 'Yes' or 'No'.
Move on to EMERGENCY CONTACT #1. Fill in the contact's Name, Email, Home Phone, Street Address, Cell Phone, City, Relationship, State, and Zip Code.
Repeat the process for EMERGENCY CONTACT #2 using the same fields as above.

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