If you are concerned about the health, well being, or safety of any individual on campus, you may complete this form.
Examples of why you may fill out the form include persons who are:
This is obviously not a complete list, but should give some idea of types of issues of concern.
Please complete the form if you have any reason to worry about a personís health or safety. This form is designed to help the person you are concerned about, not to punish him or her. You may remain anonymous and still submit this report, so you do not need to fear negative consequences to you for filling this out. The form will be reviewed in order to determine the best way to help manage the situation. This could include meeting with the person filing out this form or contacting the person of concern.
Answer as best you can. Fill out as many of the following questions as you can.
Items indicated with the are required fields to process your request.