Washington State University Logo

Student Care Referral Form


When students are in distress, early intervention can make a big difference in outcomes. Thank you for sharing information that will allow us to connect students with the resources they need.

Faculty Guide for responding to disruptive classroom behavior.

What Happens Now?
Your campus' Student Care Team will review the information and determine next steps. Someone from the team may call you for more information, or to follow up with you. We may work with you to help you resolve the situation yourself, or step in with referrals or other actions. The Student Care Team may also review the situation, if necessary. If you have any questions, please feel free to contact your Student Care Team Chair. 

FERPA: If you have a concern about a student's safety and well being, sharing that concern with another educational official at WSU who might be able to help is NOT a violation of FERPA.

The information collected in this report is an educational record, and the student may request to see it.

If you are a student and would like to request resources and support for yourself, please fill out our Student Care Request for Resources. We will be in touch with you during business hours (Monday-Friday from 8 am - 5 pm) to connect you with resources and help you navigate any challenges you are experiencing. 

Reporter Information

Please provide your name and contact information below.

 
Enable additional features by logging in.
Email address must be of a valid format.
Learn more
(eg. Faculty, Advisor, Friend, Roommate, Parent, RA/RED, Staff)
This field is required.
This field is required.
This field is required.

Involved Parties

Please list the individuals for which you are submitting this report. Please include as much information as you have available.

Involved party 1

Questions

This field is required.
Have you addressed the concern directly with the individual(s)?(Required)
This field is required.
This field is required.
Are you aware of any related services the individual is currently receiving?(Required)
This field is required.
This field is required.
What type of support do you believe might be most beneficial to the involved students at this time (mark all that apply):(Required)
You must make at least one selection.
What method of communicating with the individual has been most successful for you?(Required)
This field is required.
Is the individual aware that you are submitting this referral?(Required)
This field is required.
If the student is aware that you have submitted this referral, did they indicate one or more of the preferred types of contact? (mark all that apply)
You must make at least one selection.

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