'Canes Care for 'Canes

Who is completing this report?

The 'Canes Care for 'Canes online report allows students to report concerns that they have about their fellow Canes while remaining anonymous, if they choose to.

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Your name:

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Who is the student you are concerned about?

Name

Phone (if known)

Email (if known)

Does this person live on Campus?

Description of Your Concerns

This form should not be used for emergencies; information reported here will be addressed on the next business day.

Please describe your concern with enough detail for University staff to understand what the issues are that need to be addressed. An example description might read:

Two weeks ago Stephanie told me she was upset about a break up. Since then I noticed that she has been acting differently, not going to class or her club meetings that we have together. She doesn’t have meals with me or our other floormates anymore and I hardly see her because she comes back to the room at weird hours. I’m just not sure what to do.

Describe your concern in detail (Include nature of concern, description of behaviors, observable physical signs, events that have occurred and any other pertinent information)(Required) This field is required.

What is your relationship to this individual?(Required) This field is required.

How long have you been aware of this concern? This field is required.

How frequently, this semester, has the student exhibited the concerning behavior? This field is required.

Please list the clubs/organizations the student is involved in, especially if any of the concerns have been seen while participating in these groups. This information may be used when a staff member reaches our to a student and helps us understand the issues in context. This field is required.

Which University faculty or staff have you discussed this concern with? (if any) This field is required.

Disclaimer: The ’Canes Care for ’Canes online report allows students to report concerns that they have about their fellow ’Canes while remaining anonymous if they choose.(Required)

I agree with the above disclaimer and I understand that the form I am submitting is not for an emergency.

You must make at least one selection.

Supporting Documentation

Please attach any documents here. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Who is completing this report?

Who is the student you are concerned about?

Description of Your Concerns

Supporting Documentation

Submission