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Student of Concern Reporting Form

If this is an emergency and you need to report an imminent threat to or life-endangering situation involving a student, please call the Vanderbilt University Police Department at (615) 421-1911 or 911 prior to completing this reporting form. The Student of Concern Reporting Form is not designed as an emergency response notification process.

This form should be used:

To provide information about a student who is exhibiting behaviors that are of concern in relation to their personal, physical, or emotional wellbeing;
To provide information about a student who is experiencing a triggering event;
When you believe a student could benefit from increased support

For more information on assisting students of concern and what happens once this form is submitted, please visit the Helping Others tab on the Student Care Network web page.

To report violations of University policy, sexual misconduct, discrimination, an Honor Code violation, or acts of hazing, please utilize one the following reports:

For violations of University policy, please make a report using the General Incident Reporting Form.
For sexual harassment or sexual misconduct, please make a report using the Title IX Office’s incident report.
For acts of discrimination, harassment, and/or retaliation, please make a report using the Equal Opportunity and Access Office’s incident report.
For Honor Code violations, please make a report using the Undergraduate Honor Code Incident Reporting Form.
For acts of hazing that may violate University policy and/or Tennessee state law, please make a report using the Hazing Incident Reporting Form.
These forms and more information can also be found on the Student Affairs web page.

Background Information

FACULTY MEMBERS: Please select the SCHOOL in which the involved student is enrolled, if known, in the required field below.

STAFF, RA's, OTHER COMMUNITY MEMBERS, STUDENTS, AND FAMILY MEMBERS: Please select involved student's RESIDENCE, if known, in the required field below.

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Student's School or Residence(Required):

This field is required.

Learn more

FACULTY: select School; ALL OTHERS: select Residence

Involved Student

Please identify the student using the fields below.

Student's Name

Select Role

ID Number

Questions

Supporting Documentation

If applicable, please upload any relevant supporting documentation. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.