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Campus Access, Retention & Equity (CARE) Team Reporting Form


If you need to report an emergency, please call University Police at 805-437-8444, or dial 911



CSU Channel Islands (CI) maintains a Campus Access, Retention and Equity (CARE) Team that provides guidance and assistance to students who are experiencing crisis, displaying odd or unusual behaviors, or engaging in other behaviors that may be perceived as being harmful or threatening.

If you would like to report an incident of discrimination, harassment (including sexual harassment, sexual misconduct, and/or gender based dating and domestic violence or stalking), or retaliation please submit a report here: Referral to Title IX & Inclusion Office

To report a possible Student Conduct violation or incident of Academic Dishonesty, please use the forms located here:

Academic Dishonesty Incident Report Form
Student Conduct Incident Report Form

Your Information

Please note a member of the CARE Team will reach out to you prior to contacting the student.

 
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i.e. room location within Building or Residence

Involved Parties

Involved party 1

Information Regarding Concern

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I am concerned about the following behavior(s) (Check all that apply):(Required)
You must make at least one selection.
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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 the University Police Department notified?(Required)
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Was anyone transported to the hospital, jail, or other location?(Required)
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What has been the best method of communicating with the student?(Required)
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Is the student aware that a CARE referral is being submitted on their behalf?(Required)
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Does this student live on campus?(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