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Concerning Behavior Referral


Thank you for sharing your concerns for a student or employee at NC State. By sharing your concerns, you are helping to maintain NC State as a healthy and safe campus environment.

BEFORE YOU BEGIN: If this is an emergency that involves an imminent risk of harm to self or others, please contact campus police at 919.515.3000 or by dialing 911 prior to filling out this referral form. This referral form is designed to report behavior the reporter sees as concerning, worrisome or threatening. We appreciate your sharing concerns about NC State students, employees and guests as it helps to maintain NC State as a healthy and safe campus environment. Please note that referrals are reviewed during normal business hours and are not monitored after hours, on weekends, or during official University holidays. While referrals from this form are reviewed by a variety of campus partners working to assist students and employees, it is NOT designed for emergency response situations. Emergency Response situations should be reported immediately to campus police. That being said, if the information in the referral is determined to be emergency-related, law enforcement may become involved to check on the immediate well-being of our student or employee.

For assistance or consultation during business hours while completing this referral, please contact Prevention Services at 919.515.4405 for student concerns or the Risk Assessment Case Manager and Violence Prevention and Threat Management at 919.513.4224 for student and employee concerns.

Tell Us About You:

If you wish to make an anonymous report of concerning or worrisome behavior, a case manager will evaluate the report and determine what follow up (if any) is necessary to address the concerns. Please consider providing your name and contact information to allow us to call or email if we have additional questions regarding your report.

 
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Email address must be of a valid format.
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This field indicates the affiliation of the person exhibiting the concerning behavior.
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If more than one incident, please refer to the most recent one and use that date.
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If more than one location, choose the most recent and provide detail using the text box below

Tell Us Who You Are Concerned About:

Please list the individuals involved, including as many of the listed fields as you can provide. For individuals who are not affiliated with NC State, please provide a Drivers License number in the block labeled SID if available. If you have listed your information as the person submitting the report, you DO NOT need to include your information below. The NCSU ID Number MUST include all nine digits.

Involved party 1

Tell Us About Your Concerns:

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Based on the description you provided, please check any behaviors below that have led you to be concerned about the individual involved (optional).
You must make at least one selection.
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I understand that referrals from this form will be received during normal business hours (M-F, 8AM - 5 PM) and are not monitored after hours, on weekends, or during official University holidays. Please contact campus police at 919-515-3000 if there is an immediate risk of harm to self or others prior to submitting this form.(Required)
You must make at least one selection.

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

(For police use only): If other departments or individuals should receive a copy of this report, please select them below:
(For police use only): If other departments or individuals should receive a copy of this report, please select them below:

Submission