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CARE Referral Form

Campus Awareness Resources & Education


Faculty, staff, students, and others may have a need to refer a student who may be struggling with academic, personal, or emotional difficulties or who may be exhibiting concerning behavior. The CARE Team meets weekly to review all cases sent into the team. All cases are confidential due to FERPA and you may not receive any response from the team, which is normal. Your concern will be routed to the appropriate office depending on the nature of the concern as described below.

To maximize the ability of the CARE team to provide appropriate and timely support some fields on the following form are required. We appreciate complete information where and when available and encourage you to share as much information as possible.

Referrals made using this form do not violate student privacy rights.

Reporter Information

Please provide your contact information so that we may follow up with you as needed.

 
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(Faculty, Staff, RA, friend, parent etc.)
Email address must be of a valid format.
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This must be filled out if you would like the report to be emailed to you.
This field is required.
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Please select the best option from the list below.
This field is required.
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How would you best describe this persons behavior?
This field is required.

Information About the Person of Concern

Please provide identifying information about the person of concern. We encourage you to also include contact information for anyone else who may be willing to speak with the CARE Team about similar concerns.

Involved party 1

Specific Information Regarding the Concern

Please complete the sections below in an objective and factual manner, avoiding labels or stereotyping.

This field is required.
This field is required.
Academic Concerns Observed
You must make at least one selection.
Personal or Emotional Concerns Observed
You must make at least one selection.
Physical Concerns Observed
You must make at least one selection.
Spiritual
You must make at least one selection.
Have you talked to or corresponded with this person about your concern?(Required)
This field is required.
This field is required.
Do you need support from a CARE team member in terms of how to manage/respond to this situation?
You must make at least one selection.

Optional Supporting Documentation

Please upload any relevant documents to assist the CARE team in supporting the person of concern. This can include photos, video, email, and other materials. Maximum 12 megabytes per file. Attachments require time to upload, so please be patient after you click to submit this report. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission