Student of Concern CARE or TART Referral

Your Contact Information

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of the Concern(Required):

This field is required.

Referral to SCC and/or UPD(Required):

This field is required.

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If Student Counseling (SCC) or University Police (UPD) may need to be involved, please indicate this

Date of Incident(Required):

This field is required.

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This can be an actual incident date or date at which a change or concern was noted.

Advisor: Alert-Based Referral(Required):

This field is required.

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For academic advisors: indicate if the student is unresponsive/has a high number of alerts

Student or Students of Concern

If you are reporting an individual who is displaying concerning behavior, please submit separate referrals for cases of multiple students whose cases are unrelated. However, if your report has numerous individuals who are all involved in the same case, you may include all of the involved parties who require intervention below.

Name

ID Number (if known)

Concern or Issue

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Your Contact Information

Student or Students of Concern

Concern or Issue

Supporting Documentation

Submission