Delaware County Community College Logo

CARE Team Referral


The intent of this form is to help address concerns facing your students or a student in one of your classes, groups or circle of friends. We appreciate you sharing information about members of our College community. The goal is to outreach to address issues impacting our students' educational experience. Thank you for sharing information about a member of the DCCC Community. Your referral will help make a healthy and safe community for all.

Reasons for referral:

  • Concern about a student's behavior
  • A student's behavior indicates acute personal distress
  • Outside concerns (health, financial, family, etc.) impacting success at the College
  • A student exhibits alarming, atypical, and/or unusual behavior
  • Concern a student is suffering from impaired mental status
  • Concern the student may have thoughts of suicide
  • A pattern of disruptive or disturbing behavior

Please be advised that this reporting resource is monitored from Monday through Friday, 9 am to 5 pm.

  • If there is an immediate life-threatening mental health emergency, call 911 for police and ambulance/paramedic response for transport to local hospital.  If there is an acute need for mental health services, call 988.  Examples of acute need include talking about suicide, talking about harming oneself, overuse of drugs or alcohol, extreme depression, anxiety or other mental health symptoms, or a self-injury that does not need medical attention.  
  • You may also call the Delaware County Crisis Connection Team at 1-855-889-7827, the Chester County Crisis Service at 610-280-3270, or in Philadelphia 215-686-4420.

 

About You

You may leave this information blank and submit anonomously. Sharing your information will help us follow-up with you and gather more information. Anonymous reports may also limit our response.

Learn more
Anonymous reporting is allowed, but this may impact our ability to fully assist the student.
Email address must be of a valid format.
This field is required.
This field is required.

Who Are You Concerned About?

Please provide as much information as you are able to so that the CARE Team can properly identify the student(s). This section also includes an opportunity to report anyone else involved in the situation who might be able to provide more information.

Involved party 1

Tell Us About the Concern/Behaviors

Academic Concerns - Check all that apply
You must make at least one selection.
Physical Behaviors
You must make at least one selection.
Emotional Behaviors
You must make at least one selection.
Personal Concerns
You must make at least one selection.
Threatening Behaviors
You must make at least one selection.
Have you talked to or corresponded with this individual about your concern?(Required)
This field is required.
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.

Submission