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Student in Distress Referral


Please note that this is not a crisis report. If the student you are referring poses an immediate threat to self or others, please call 911 or UAB Police at 205-934-3535. Additional information about mental health crisis and emergencies can be found on the Student Counseling Services website.

Please complete the following form to alert the University of a current UAB student who may be in distress or is exhibiting concerning behavior. The form can be used for one incident or for concerns regarding a pattern of behavior. We accept referrals from any person who is concerned about the wellbeing of a current UAB student.

A staff member in the Office of Student Assistance & Support will review the information within one (1) business day and determine appropriate next steps, which may include contacting you, the referred student, or any other individuals who may have relevant information. Information may also be shared with the University’s multidisciplinary CARE Team or a wellness check may be conducted by Residence Life (if a residential student) or UAB Police.

For additional information, contact Student Assistance & Support at 205-975-9509 or visit the Student Assistance & Support website.

Referral Source Information

 
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Does this referral involve any of the following? Please note that this is not a crisis report.
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Student in Distress Information

Please list the individuals involved (excluding yourself), and provide information for as many of the listed fields as you are able. Do not create an ID number if you do not know it.

If you are submitting the referral on your own behalf, please include your information below.

Roles in which the individuals may be involved include the following:

  • Student in Distress: student who may be in distress or is exhibiting concerning behavior;
  • Witness: individual (excluding yourself) who can provide additional information;
  • Other: individual who is not a member of the University community.
Involved party 1

Referral Information

Please provide as much information as you are able in the following questions.

Please select all of the concerns or behaviors that may apply:(Required)
You must make at least one selection.
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What is the duration of the behavior(s)?(Required)
You must make at least one selection.
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While the behavior(s)/concern will be directly discussed, do you have any concerns with our staff acknowledging your referral to the student in distress?
You must make at least one selection.
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Supporting Documentation

Please provide any supporting documentation (e.g., emails, writing assignments, photographs) that you believe would help determine the most appropriate next steps. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission