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Student & Staff Emergency Self-Identification Form

UIC Law is committed to ensuring the safety of students, employees, and other visitors to all buildings. That commitment includes providing assistance to employees with disabilities or certain medical conditions during an emergency. Such persons are requested to identify their need for assistance and to specify what is required for a safe evacuation of the building during an emergency.

This document is a voluntary self-identification form through which students, employees, and visitors with disabilities may identify their need for assistance during an emergency. The information requested on this form is for the sole purpose of deploying assistance to the undersigned person during an emergency. The Rehabilitation Act of 1973, as amended, requires that medical information about applicants be kept confidential except for that provided to first aid, first responders, and safety and health personnel. Thus, the Director of Safety & Security, Fire Safety Director, Life Safety Coordinator for Campus Safety, and the Security Department may share information about the type of assistance and individual needs with medical professionals, emergency coordinators, emergency evacuation personnel and security officials who need to confirm that everyone has been evacuated, and other non-medical personnel who are responsible for ensuring emergency preparedness.

Emergency Self-Identification Form Heading link

Student and Staff: This form will be submitted to the Campus Safety & Security Department via email. You may visit them in person at 300 S. State Street Lobby.

A confirmation of this form will be sent to the email address provided above. If you have any questions, please call the Director of Campus Safety & Security at (312) 386-2823.