Care Team Form

Background Information

Enable additional features by logging in.

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Learn more

Required if you want to be notified when contact is initiated for this report.

Relationship to student(s)(Required):

This field is required.

Learn more

The position you hold in relation to the student(s) of concern.

Urgency of this report(Required):

This field is required.

Learn more

Perceived impact on well-being (social, academic, physical, and/or mental wellness).

Location of incident(Required):

This field is required.

Involved Parties

Please list the individual(s) of concern, including as many of the listed fields as you can provide.

Name

000 + 6 digit CC ID #

Questions

Please provide a detailed description of the activities, behaviors, and/or circumstances that lead to this report. Please use specific, concise, and objective language (who, what, where, when, why, and how).(Required) This field is required.

I would like to be notified by the Community Standards & Student Support office when contact to the student is initiated.(Required)

Yes - Requires the "Your email address" field to be completed above. No

This field is required.

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.

Select copy recipients

Derrell Stinson

Amy Lewis

Email me a copy of this report

Care Team Form

If this is an emergency or a situation that needs an immediate response please contact Campus Safety at (719)389-6707 or Emergency Services at 911.

Background Information

Involved Parties

Questions

Supporting Documentation

Select copy recipients

Submission