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Care Team Referral


Thank you for sharing your concerns for a student at SXU.

Faculty, staff, students, and others may use this form to refer a student who may be struggling with academic, personal, or emotional difficulties or who may be exhibiting concerning behavior.

**If a student is undergoing a COVID-19 related circumstance that may affect their ability to attend in the future, please select the 'Retention Risk (COVID-Related)' option.**

Care Team referrals and online forms are reviewed daily (Monday-Friday). Care Team staff will investigate the issue, make a referral to the most appropriate office(s) and reach out to the student as appropriate. The Care Team may follow up with the individual initiating the report to gather additional information if necessary. The Care Team DOES NOT respond directly to emergencies through this form.

If this is an emergency, if you feel threatened, or are aware that someone is in extreme distress or at risk for harming themselves or others, please IMMEDIATELY CALL SXU Public Safety at 773-298-3911 or call 911 directly.

Background Information

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

Student of Concern Information

Involved party 1

Details regarding concerning behavior.

Please check all of the boxes that apply and provide a description of the incident(s) in the provided space. Then answer the questions to the best of your ability, objectively as possible.

NOTE: If there is risk of self-harm or harm to others, please immediately call SXU Public Safety at 773-298-3911 or call 911 directly.

Please select the reason for the referral:

ACADEMIC
You must make at least one selection.
BEHAVORIAL
You must make at least one selection.
PERSONAL/EMOTIONAL
You must make at least one selection.
This field is required.
This field is required.
This field is required.
This field is required.
This field is required.
This field is 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