ࡱ> )+(  bjbj . hz||||||?||BBB zBzBBB|)RBf0Bk2kBkB$B||Bk : Emergency Contact Form Student Intern Name: _________________________ Location in Placement:_______________________ Students Cell Phone:__________________ Primary Work Phone: _________________ Intern Parent or Legal Guardian Name:__________________________________________________________________ Home Phone: ________-________-________ Work Phone: ________-________-________ ext ________ Placement Supervisor Name:__________________________ Location in Placement:__________________________ Primary Work Phone: ________-________-________ ext ________ Alternative Contact Person at Placement Name: _________________________ Location in Placement: __________________________ Primary Work Phone: ________-________-________ ext ________ Field Coordinator Contact Information Name: Peter McCarthy Office Location: TLC 227 Primary Work Phone: 518-580-5427 Cell Phone: 518-669-7440 Program Director Name: Crystal Moore Office Location: Primary Work Phone: 518-580-5428 Cell Phone: 518-727-3401 ΢Ȧ Campus Security Number: 518-580-5566 Secretary, Department of Sociology, Anthropology, and Social Work Name: Linda Santagato Primary Work Phone: 518-580-5410  (HJw ; b  & 4   * Y hrhehn(hr>*CJOJQJaJhrCJOJQJaJhn(hr5CJOJQJaJhr5CJOJQJaJhn(hrCJOJQJaJhOGhr5CJOJQJaJ0'(IJxy1 2 Y Z : ; c d gdr$a$gdrd  `  + Y Z gdr,1h/ =!"#$% ^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH D`D NormalCJOJQJ_HmH sH tH DA D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  d  8@0(  B S  ?_a|333333reY@p@UnknownG* Times New Roman5Symbol3. * Arial5. *aTahoma9PalatinoA BCambria Math"hnZnZ!202qHX $Pr2!xxEmergency Contact FormSkidmoreLinda E. SantagatoOh+'0 , L X dpxEmergency Contact Form ΢Ȧ Normal.dotmLinda E. Santagato2Microsoft Office Word@@Ð)@Ð)՜.+,0 hp  ΢Ȧ College Emergency Contact Form Title !"#$%&'*Root Entry F),1Table kWordDocument.SummaryInformation(DocumentSummaryInformation8 CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q