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Student Concern Form


If this is an emergency, please call 911 or ESU Police and Safety (620-341-5337).

This form is for the use of current students, faculty or staff from the ESU Emporia campus. Please provide detailed information regarding the concern you are reporting. ESU does not accept anonymous reports. Once the form is received, a member of the ESU CARE Team or Student Advising Center will review the information and take appropriate action, which may or may not include contacting the student, you, and any witnesses you have identified.

If you have any questions related to filing a CARE Team report, please call (620) 341-5269 or email lbays@emporia.edu. For questions related to filing an academic early alert, please call Kathy Landwehr (620) 341-5421 or email klandweh@emporia.edu.

Background Information

 
Email address must be of a valid format.
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Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. When completing the Student ID Number field, please include E before the number. Fields may be left blank if information is not known at the time of the report.

Involved party 1

Questions

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My concern is related to (mark all that apply):(Required)
You must make at least one selection.
Did alcohol or other substances appear to be a factor?(Required)
This field is required.
Did police or ESU Police and Safety respond?(Required)
This field is required.
Was anyone transported to the hospital; jail; or other facility?(Required)
This field is 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