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Student Concerns Referral Form


IF YOU NEED TO REPORT AN EMERGENCY INCLUDING IMMEDIATE RISK TO LIFE OR PROPERTY, PLEASE CONTACT THE DEPARTMENT OF PUBLIC SAFETY AT 843-349-2911.


As the eyes and ears of the Coastal Carolina University community, it is everyone's responsibility to assist those students who exhibit concerning behavior, or are in need of individualized resources and/or support.

Referrals made on this form are routed within the Dean of Students Office. Please understand that our staff reviews reports on a daily basis, Monday-Friday, and outreach is made within 1-2 business days to our students to learn how we may be able to support them in navigating some of the challenges they may be experiencing.

If you have questions or concerns please contact the Dean of Students Office at dso@coastal.edu or 843-349-4161.

Background Information

 
Email address must be of a valid format.
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If not applicable, please enter the last date of contact with the student
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Please enter location if applicable

Student(s)

Please enter as much information as possible for the student that you are referring.

Involved party 1

Issues of Concern

Please provide information below to the best of your knowledge. Please provide a detailed description of the incident or concern in the narrative box below. Please be professional, objective, accurate and factual.

General nature of concern (check all that apply)(Required)
You must make at least one selection.
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Please share what other offices have been notified of this concern besides the Dean of Students Office, and any resources offered, if at all.
You must make at least one selection.
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Supporting Documentation

If you have any additional information (photos, videos, written statements, etc) that would be helpful in understanding the student's issue, please attach here. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission