CARE Referral

Are you concerned about a student's well-being and feel that the student needs support and resources? Tell us more by submitting a CARE Referral form.

If this is an emergency call 911.

Concern Request (DCTC)

When you click "Submit", the information you entered will be sent to DCTC. This matter will be routed to the appropriate staff or Campus Assessment, Referral, and Education (CARE) Team member and will be followed up on shortly.

Your Information

Star Id: *

Star Id: is required.

First Name: *

First Name: is required.

Last Name: *

Last Name: is required.

Phone: *

Phone: is required.

Email Address: *

Email Address: is required.

Person of concern & situation details

Name: *

Description *

Please provide any other identifying characteristics (i.e. approx. age, gender, build, height, etc.), especially if you do not know the person's name.

Situation Description *

Provide a detailed description of the concern/conduct incident using specific concise, objective language (Who, what, where, when, why, and how).

Incident Date/Time *

Please enter the date and time of the incident. Format: MM/DD/YYYY hh:mm

Interested parties or witnesses

Please provide the name and contact information for any individuals who may have additional information about this referral (if known).

Supporting Documents: Allowed file extensions: pdf,doc,docx,txt

Attach any supporting documents.