CPE REU Check List and Document Submission Form

CPE REU Check List and Document Submission Form

In preparation for the CPE REU, please use this form as a check list and submission portal for documents needed prior to your arrival to the University of Kansas Lawrence campus.

Name

Applied to KU as non-degree student:

(Please accomplish by midnight May 12)

1st Emergency Contact:

Please include contact name and relationship, Street Address, City, State, Zip, telephone, email.

2nd Emergency Contact:

Please include contact name and relationship, Street Address, City, State, Zip, telephone, email

Conditions (medical or otherwise) that we need to be aware of and/or medications you currently use:

Do you have health/accident insurance coverage valid for all of 2022?

Do you have mobility or other restrictions that require special equipment and assistance?

If yes, how can be best assist you?

Special dietary needs or allergies:

I will be bringing my own laptop for the summer

Please upload the following completed forms

The University of Kansas Watkins Health Services Immunization Screening History

TB Screening Questionnaire

Health Questionnaire Form