CARES Referral

River Valley Community College > CARES Referral

Concern Type(s)*
Please select the reason you are concerned about this individual. You may select multiple reasons by holding down the Ctrl key when you click.
Student ID:*
If you are a student referring another student, and do not know the ID#, please enter all 0s.
Description*
Please provide as much information as possible about the concern.
Supporting Documents
Drop files here or

Accepted file types: doc, xls, pdf, gif, jpg, png.
If you have any supporting documentation regarding this concern, you may upload it here (For example, photos, emails, screen shots of text messages, etc.)
Does the student of concern have a trusting relationship with at least one person?*
- Yes
- No
- I don't know
How long have you been worried about this student?*
Example: one week, a month, etc.
Have you discussed this concern with the student?*
- Yes
- No
Is the student aware you are submitting a CARES referral?*
- Yes
- No
Your Name*
First Last
Your Email*
Your Phone*
What is your relationship to the Student of Concern?
Consent*
I understand this referral will be submitted to a system that is not monitored 24/7. If this is an emergency situation, I will call 911.
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