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Dean of Students - Connect a Student to Care


Individuals who are concerned about student and are seeking assistance in supporting that student are encouraged to report their concerns through the following form. Dean of Students staff will in turn work with you to provide outreach and support to the student. If you have a concern about a student, please know that confidentiality laws do not prevent you from reporting the concern.

IF THERE IS IMMEDIATE RISK TO LIFE OR PROPERTY please call University of Northern Iowa Police at 319-273-2712.

Please complete the form as thoroughly as possible, this helps us support you and the student(s) as quickly as possible.

Background Information

 
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Email address must be of a valid format.
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Name of Student(s) in which you are concerned:

Provide any information that you have available on the student in which you are concerned.

Involved party 1

Student Concerning Behavior/ Concern for Student

Please select the following concerns that have been observed. Providing detailed description of the incident or concern will help us better address your concern.

Academic Concerns (please select all that apply)
You must make at least one selection.
Emotional Concerns (please select all that apply)
You must make at least one selection.
Social-Cultural Concerns (please select all that apply):
You must make at least one selection.
Behavioral Concerns (please select all that apply)
You must make at least one selection.
Personal Concerns (please select all that apply)
You must make at least one selection.
This field is required.
This field is required.
Is the student aware you are reaching out to the Dean of Students team for assistance supporting them?(Required)
This field is required.
How can we best communicate back with you regarding your concern for this student?(Required)
You must make at least one selection.
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