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Care Team Referral


The Care Team operates Monday - Friday 8:30-4:30 and does not respond to incidents after-hours (nights and weekends). If this is an emergency, call the Campus Safety Office at (503) 943-4444 or dial 9-1-1.

Reporting Party Information

We prefer that when you complete this form, you include your name, title, and contact information. If you prefer, you may remain anonymous and the information given remains private, meaning that it will only be shared with University professionals who have a required need to know. PLEASE NOTE: anonymously submitted forms limit our effectiveness in dealing with a concerning behavior.



If you have questions, concerns, or additional information, please reach out to careteam@up.edu

 

 
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Student of Concern and Any Other Involved Parties

Please include Student Identification Number, if at all possible. All information supplied helps in verifying the correct student of concern is reported.

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Information related to the concern reported

Please describe as objectively as possible the details of the incident(s) and the behaviors observed. Focus on the Who, What, Why, Where, When, and How. Indicate specific words, phrases, and interactions. For example, if a student has missed classes or exams, please include how many and what ways you have addressed this with the student. If a student used profanity, made threats, or spoke of harming him/herself, please attempt to indicate the actual words/phrases that were spoken. If this is a welfare concern, please describe what observations are causing you concern and/or any changes in the individual's behavior that prompted this report. AGAIN: PLEASE INCLUDE YOUR ACTIONS TO ADDRESS THIS CONCERN AND THE NAME(S) OF PERSONNEL YOU HAVE CONTACTED AND ACTION THEY HAVE TAKEN.

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I am concerned about the following behaviors (check all that apply):(Required)
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Have you addressed the concern directly with the individual?(Required)
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If this is regarding an academic concern, have you submitted an Academic Warning?(Required)
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