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Care Report


Do not use this form to report an immediate threat. If the person you are concerned about is a danger to themselves or others please stop and call 911 before submitting this form. 911 is automatically routed to SIUE PD if called from a campus extension. 

If this is a report about sexual misconduct or relationship violence please submit a Sexual Assault, Sexual Misconduct and Relationship Violence Incident Report using: https://cm.maxient.com/reportingform.php?SIUEdwardsville&layout_id=4.

The purpose of a Care Report is to share concerns with a student, whether it's tied to their well-being, academic performance, or other concerns, with the Dean of Students and Counseling Services for them to review to see what, if any, steps should be taken. Concerns about a staff or faculty member should instead be routed to Human Resources, their direct supervisor, department head, or SIUE PD.

Please read through the options carefully as the form has recently been changed.

Background Information

Since many reports are not seen immediately, please call 911 for any student who is experiencing suicidal ideation or homicidal ideation and a plan of intent to harm self or others.

Please provide your contact information below in the event we have follow up questions or concerns.

 
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Ex. Faculty, Staff, Studnet, Parent, Friend, Family Member, Concerned other
Email address must be of a valid format.
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Involved Parties

Please list the individual(s) that you are concerned about, including as many of the listed fields as you can provide.

If you do not provide a first and last name or 800 number we will not be able to identify the person(s) you are concerned about and will be unable to follow up.

Involved party 1

Information

Please be as detailed and complete as possible. If you have noted observations over several dates, you will be able to make those clarifications later on.

I'm concerned about someone's well-being (select all that apply):
You must make at least one selection.
I'm concerned someone may have violated the Student Code of Conduct (select all that apply):
You must make at least one selection.
I'm concerned about a student's academic progress (select all that apply):
You must make at least one selection.
This field is required.
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This report may not be reviewed immediately.(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.

Submission