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CARE Team Report


If you are submitting a concern related to the *imminent safety* or *potential imminent safety of a student for any reason*, or you have submitted a report or emailed and it is an *emergency situation*, you need to call *Fitchburg State University Police at 978-665-3111*. Submitting a report is not sufficient to provide the needed assistance to any person, as it is not meant to provide immediate alert to the Dean of Students Office or other staff.

Please complete this form to report concerns regarding a student. This report will be routed to the Office of Student Affairs, Dean of Students and CARE Team for review. If you have questions regarding a report and/or would like to speak to someone, you should call the Office of Student Affairs at (978) 665-3130. Your name and contact information is not required, but the CARE Team may be limited in their ability to respond if this information is not available. Confidentiality will be protected by the University's FERPA policy and as such there may be limited updates that can be provided once the report is filed.

To file an incident report with Student Affairs for student conduct, public health violations, or other issues (not CARE Team), please CLICK HERE.

To file an incident report with the Title IX Coordinator or Deputy Title IX Coordinator for EO Plan Related Concerns (Discrimination or Discriminatory Harassment, Sexual Violence, or Retaliation, please CLICK HERE.

To file an incident report for alleged violation of the academic integrity policy, please CLICK HERE.

To file a report with the Bias Incident Response Team, please CLICK HERE.

Reporter

 
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Involved Parties

Please list the student(s) involved, including as many of the listed fields as you can provide. For non-students, please list any ID information available. Please select 'Add another person' for anyone else who may be willing to speak with the CARE team about similar concerns.

Involved party 1

Questions

Please check all of the boxes that apply and provide a description of the incident(s) or student contact in the provided space. Then answer the questions to the best of your ability, objectively as possible.

Nature of Report
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Academic Concerns
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Have you connected with the student about your concerns?(Required)
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From this incident, are you concerned for your safety? (If you have immediate concerns, please contact University Police at 978-665-3111 or dial 911!)(Required)
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* From this incident, are you concerned about the safety or health of the student?(Required)
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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.

Submission