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 of Concern Name*
First Last
List the name of the student you are concerned about.
Student of Concern email
Student of Concern phone number
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
Your Name
First Last
Providing your name and contact information is optional. If you choose to include your information, we will work to keep this referral as confidential as possible but your anonymity is not guaranteed as the student of concern is contacted. If you would like to remain anonymous, please do not put in any information about yourself. Thank you.
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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