CARES Referral - River Valley Community College

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.

State where student resides (this will help the team identify appropriate resources)

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, Max. file size: 256 MB.

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?

How can the CARES Team best assist you?*

I need resources.
I have the resources I need, I just want the team to be aware.
I would like to talk through this situation with a CARES team member.

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.

CAPTCHA

Academic Performance
Anxiety
COVID-19
Dating/Domestic Violence
Depression
Family
Financial
Food Insecurity
General Safety Concern
General Stress
Housing Insecurity
Loneliness or Isolation
Medical
Self-harm
Sexual Assault
Sexual Harrassment
Stalking
Substance Use
Suicidal Ideation
Other