Student of Concern Report
Name
First
Last
Email
Phone Number
-
Area Code
Phone Number
Urgency of this report
Normal
Urgent
Call 911 (You, filling out this form, should call 911 if it is this urgent)
Student's Name
Description/Narrative of concern(Please include as much information as possible.)
Type of concern (check all that apply
Mental Health
Suicide
Struggling Spiritually
Academic
Social
Other
Have you addressed your concerns with the student directly?
Yes
No
Describe any steps you or others have taken to address the issue.
Have Campus Security of Stephens County Sheriff's Department been notified?
Yes
No
Is the student of concern aware that Student Affairs is being notified of this concern?
Yes
No
While we do our best to keep Student of Concern Reports confidential, at times it is necessary to identify the reporting party. If necessary, may we share your name with the student?
Yes
No
Submit
Should be Empty: