Home / Student Concern Form

Individuals who are concerned about a student and are seeking assistance in supporting that student are encouraged to report their concerns through the following form. Members of the CARE Team will in turn work with you to provide outreach and support to the student. If you have a concern about a student, please know that confidentiality laws do not prevent you from reporting the concern.
Please complete the form as thoroughly as possible, this helps us support you and the student(s) as quickly as possible.

Background Information

Your full name:
Your email address:(Required)
Urgency of this report:(Required)
Location of Incident:(Required)
Name of Student(s) in which you are concerned:

Student Concerning Behavior / Concern for Student

Please select the following concerns that have been observed. Providing detailed description of the incident or concern will help the CARE Team better address your concern.
Academic Concerns (please select all that apply):
Emotional Concerns (please select all that apply):
Social-Cultural Concerns (please select all that apply):
Behavioral Concerns (please select all that apply):
Professional Concerns (please select all that apply):
Please tell us about your relationship to this student.(Required)
Is the student aware you are reaching out to the CARE team for assistance and supporting them?(Required)
How can we best communicate back with you regarding your concern for this student?(Required)
Max. file size: 50 MB.
Photos, video, email, and other supporting documents may be attached below.