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Concerning, Worrisome, or Threatening Behavior

Thank you for reaching out to the Central Piedmont Care Team. You are helping to maintain a healthy and safe campus environment.

BEFORE YOU BEGIN: If this is an emergency that requires immediate attention, please contact College Security/Police Services at 704-330-6911 prior to filling out this referral form. While referrals from this form are reviewed by a variety of campus partners working to assist the college community, it is NOT designed as an emergency response notification process.

Background Information

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please tell us about the people who are involved.

Name

Role

SID Number

Phone number

Email address

Description / Narrative

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.

Background Information

Involved Parties

Description / Narrative

Supporting Documentation

Submission