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CARE Team Referral Form


If this is an emergency that involves imminent risk of harm to self or others, please contact Ohio University Police Department at 740-593-1911 or by dialing 911 prior to filling out this referral form. 

Submission Instructions: This form can be used by anyone concerned about a student who may appear distressed or whose behavior is disruptive. The CARE Team reviews the information you provide, takes the most appropriate action, and makes the necessary referrals and support. Please provide as much information as you can. If there are questions you cannot answer or information you are uncomfortable sharing, simply skip those entries. If you would like to first talk to someone about your concerns, call the Office of the Dean of Students at 740-593-1800.

Information About You

 
Email address must be of a valid format.
This field is required.
This field is required.

Information Regarding the Student you are Concerned About

You do not need consent from the at-risk student to make a referral and may do so without their knowledge. Please share with us all the information you have regarding the student.

Involved party 1

Questions

This field is required.
Please describe your relationship to the student (please tell us who you are as the referring person):(Required)
You must make at least one selection.
This field is required.
General Nature of Concern (check all that apply)(Required)
You must make at least one selection.
This field is required.
This field is required.
This field is required.
This field is required.
Is the student aware that you are completing this report and anticipating outreach?(Required)
This field is required.
Would you like to talk to the Office of the Dean of Students' staff before any outreach to the student?(Required)
You must make at least one selection.
This field is required.
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. Additionally, I understand that outreach may be made to the referred student as deemed necessary by the Dean of Students Office. If this is an emergency that involves imminent risk of harm to self or others, please call the Ohio University Police Department at 740-593-1911 or by dialing 911 immediately. If this is an emergency that involves an imminent risk of harm to self or others, please contact Ohio University Police Department at 740-593-1911 or by dialing 911 prior to filling out this referral form.(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