C.A.R.E Report

Name(Required)

First Last

Position/Title(Required)

What are you reporting

Academics Indicators

Emotional / Psychological Indicators

Behavioral / Social Indicators

Physical / Safety Indicators

Concerning Communications

Contextual / Situational Indicators

Date of Incident(Required)

Time of Incident(Required)

Involved Parties

Please list the individuals involved (excluding yourself); including as many of the listed fields as you can provide. If you are referring an organization, (e.g., an athletic team, a registered student organization, etc.) please put the organization's name in the "Student's Name" box.

Students Name

First Last

Select Gender

Select Role

Resident

Add Another Party

Yes

Additional Student Name

First Last

Select Gender

Select Role

Resident

Details

Please describe the situation that prompted this report. Provide a detailed description of the incident/concern using specific concise, objective language (who, what, where, when, why, and how). If applicable, describe any steps you have taken to address the concern.

Details(Required)

Were police involved or contacted?(Required)

Yes

Would you like someone from the appropriate office to contact you?

Yes

It's not necessary, unless additional information is needed.

If yes, you must include your name, phone number, and email address in the Background Information section above.

Supporting Documents

Drop files here or

Max. file size: 50 MB, Max. files: 10.