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Student of Concern Referral Form


Rollins cares deeply about providing a safe and secure environment to learn and work. If you are concerned about a Rollins community member or are concerned about a specific incident, you can report your concerns on this form below.

**In the event of an emergency, please call Winter Park Police at 911 or Campus Safety at 407-646-2999**

Tell us more:

We do not require your name to respond to these cases. However, our ability to address anonymous incidents can sometimes be limited. It is often very helpful to know who is making the referral so we can follow-up most appropriately.

 
Learn more
(Parent, Faculty, Friend, Roommate, Staff Supervisor, Other)
Email address must be of a valid format.
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Tell us who:

Involved party 1

Tell us issue of concern:

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Nature of Concern (check all that apply):
You must make at least one selection.
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How were you referred to this form?(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