Student Referral Form
If you are in contact with a student who has taken actions to end his or her life, please immediately seek medical assistance by calling 911.
We encourage you to refer students who are having personal problems that are interfering with their academic success. All students who have made public statements and/or have taken action that places them at risk for self-harm or harm to others should be referred. If there is any doubt about whether the student has met the requirements for referral or not, you should fill out this form. You can also consult with the Counseling Center to determine whether to complete this form.
If you encounter a student about whom you have concerns, please talk with the student and fill out this form as completely as possible. If you have any questions you can call the Counseling Center during office hours.