Summer Contact Info

Note: Fields marked with an asterisk ( * ) are required.

STUDENT
* First Name:
* Last Name:
* Phone Number:
Cell Phone Number:
* E-mail:
Note: make sure this e-mail will be active during the summer
* Mailing Address:
Please include street address, city, state, country, and postal code
* Billing Address:
Same as above (skip next box)
Different (please list):

PARENT/GUARDIAN 1
* First Name:
* Last Name:
* Phone Number:
E-mail:
Mailing Address:
Same as student mailing address
Same as student billing address
Different (please list):
* Relationship to Student:
PARENT/GUARDIAN 2
First Name:
Last Name:
Phone Number:
E-mail:
Mailing Address:
Same as student mailing address
Same as student billing address
Same as parent/guardian 1 address
Different from all above adresses (please list):
Relationship to Student:

Student Affairs

David Gilson

Associate Dean for Student Affairs

216.791.5000 ext. 299

david.gilson@case.edu

Elisha Hermann

Administrative Assistant to the Dean

216.791.5000 ext. 273

exh20@case.edu

April Martin

Resident Director, Cutter House

resident.director@cim.edu

Student Groups

Student Government Association

SGA page

sga@cim.edu

Mu Phi Epsilon

MPE page

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