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Referring a Student of Concern


Who should use this form

This referral form is for the use of current students, faculty, staff as well as University of North Carolina Asheville community members. Please provide detailed information regarding the concern you are referring. Once the form is received, a member of the Dean of Students team will review the information and take appropriate action, which may or may not include contacting the student, you, and any others you have identified. If you have any questions related to completing a Student of Concern report, please email dos@unca.edu.

If you need to report a Bias Incident, please use this form.

DO NOT USE THIS FORM IN THE CASE OF AN EMERGENCY. IF THERE IS AN IMMEDIATE THREAT TO ANY PERSON OR PROPERTY CALL UNIVERSITY POLICE, (828) 251-6710 (on campus emergencies), OR 911 (off campus emergencies). This form is not monitored outside of regular business hours, Monday through Friday from 8:00am-5:00pm.

Background Information

 
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Email address must be of a valid format.
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Involved Student Information

Involved party 1

Information Regarding the Concern

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I am concerned about the following personal, emotional, or behavioral concerns (check all that apply):
You must make at least one selection.
I am concerned about the following academic behaviors (check all that apply):
You must make at least one selection.
Have you addressed the concern directly with the individual?(Required)
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Are you aware of any related services the individual is currently receiving?(Required)
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Was anyone transported to the hospital, jail, or other location?(Required)
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Was University Police notified?(Required)
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How would you like us to follow up with you?
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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