Share a Concern

Do not use this form to report a student who is in immediate crisis or danger, please contact University of Colorado Police Department for assistance on 303-492-6666, or call 911, if you believe your safety or the safety of the student may be at risk.

This form may be used to identify a student who is struggling with academic, personal, emotional, or mental health problems. This form is reviewed by the Dean of Students and the Student of Concern Team Case Manager. Once a student of concern has been identified, a representative from the Division of Student Affairs will reach out to the student and offer support. Please note, while anonymous reporting is an option, it may greatly limit our ability to reach out and respond to your concerns, including providing adequate assistance to the parties involved.

If you have questions about how to use this form and what information to report, please contact the Division of Student Affairs at 303-492-8476 for assistance.

Reporting Party Contact Information

Your name (first last)

Phone

Email address

Relationship to student

Student of Concern

Name of student *

Student address

City, State ZIP

Student phone *

Student email address

Follow Up

Have you discussed this report with the student? *

Yes

Would you prefer to remain anonymous? *

Yes

May a representative of the SOC team contact you if we need additional information? *

Yes

Have you reported this information to anyone else? *

Yes

If yes above, who?

Background Information
Please share any background information you may have about this student including any prior incidents of concern, distressing life events, or other information that would help the SOC team better understand this student.

Current Incident or Behaviors of Concern
Please describe, in detail, the specific conversation, behavior, or incident that is of concern to you.

Please Note: Supervisors may not use this form to satisfy their obligation to report allegations of sexual harassment or protected class discrimination or harassment. Pursuant to the University’s Sexual Harassment Policy and Procedures and the campus Discrimination and Harassment Policy and Procedures, supervisors are required to report such allegations directly to the appropriate Discrimination and Harassment Officer, either the Director of the Office of Student Conduct or the Director of the Office of Discrimination or Harassment. You may review your reporting requirements at: http://hr.colorado.edu/dh/Pages/default.aspx

Please visit the Student of Concern Team for additional resources and support when working with students of concern.

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