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CARE Team Form


If this is an emergency, please call 911 or ESU Police and Safety (620-341-5337).

This form is for the use of current students, faculty, or staff from the ESU Emporia campus. Please provide detailed information regarding the concern you are reporting. ESU does not accept anonymous reports. Once the form is received, a member of the ESU CARE Team will review the information and take appropriate action, which may or may not include contacting the student, you, and any witnesses you have identified. If you have any questions related to completing this form, please call (620) 341-5269.


Reporter's Information

 
Email address must be of a valid format.
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Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. When completing the Student ID Number field, please include E before the number. Fields may be left blank if information is not known at the time of the report.

Involved party 1

Specific Concerns

I am concerned about the following behaviors (check all that apply):(Required)
You must make at least one selection.
Have you addressed the concern directly with the individual?(Required)
This field is required.
Are you aware of any related services the individual is currently receiving?(Required)
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Did law enforcement respond?(Required)
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Was anyone transported to the hospital, jail, or other location?(Required)
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Did alcohol or other substances appear to be a factor?(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