Campus Assessment, Response, Empowerment, and Support (CARES) Form

The CARES team is not an emergency response team. If this is an emergency, you are in need of immediate assistance, or there is the threat of imminent danger to self or others, please call 9-1-1.

Number of students involved (if more than 6, please submit multiple forms)
Student name & 900# (if known)
Student name & 900# (if known)
Student name & 900# (if known)
Student name & 900# (if known)
Student name & 900# (if known)
Student name & 900# (if known)
Student's name & 900# Student's name & 900#
Student's Name Student's 900# (if known)
Nature of your concern
Housing

Housing On-campus Off-campus
Name of person submitting referral
(You may report anonymously; however, please understand that choosing to do so may limit the Care Team's ability to follow up with adequate support.) Name of person submitting referral
(You may report anonymously; however, please understand that choosing to do so may limit the Care Team's ability to follow up with adequate support.) First Last
Relationship to the student

Relationship to the student Faculty Staff Peer Community Member Self Parent/Guardian Other (please specify) Other (please specify)
Email of person submitting referral
Phone number of person submitting referral Phone number of person submitting referral - ### - ### ####
Is the person you are referring aware you are reaching out to the CARE team?

Is the person you are referring aware you are reaching out to the CARE team? Yes No
How can we best communicate with you regarding your concern?

How can we best communicate with you regarding your concern? Email Telephone call Text message No communication needed
If you have any relevant documents or evidence related to your concern, please upload them here.

Attach Files
Confidentiality Statement: By submitting this form you acknowledge that the information provided is true and accurate to the best of your knowledge.
By submitting this form you acknowledge that the information provided is true and accurate to the best of your knowledge.

Campus Assessment, Response, Empowerment, and Support (CARES) Form

Campus Assessment, Response, Empowerment, and Support (CARES) Form

By submitting this form you acknowledge that the information provided is true and accurate to the best of your knowledge.