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Share a Concern Reporting Form


IF THERE IS IMMEDIATE RISK OF HARM TO SELF or OTHERS
Call 911, then 603-641-7000


Faculty, staff, students, and others may refer a student who may be struggling with personal, or emotional difficulties or who may be exhibiting concerning behavior. While referrals from this form are reviewed by a variety of campus partners working to assist students and employees, it is NOT designed for emergency response situations.

While no fields on the following form are required, we appreciate complete information where available. This form is routed to the Dean of Students Office. Completing this form does not constitute filing a police report, nor does this report serve as official notice to Community Standards & Student Conduct.

Tell Us About You:

If you wish to make an anonymous report of concerning or worrisome behavior, someone will evaluate the report and determine what follow up (if any) is necessary to address the concerns. Please consider providing your name and contact information to allow us to call or email if we have additional questions regarding your report.

 
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(Student, Faculty, Staff, Supervisor, etc.)
Email address must be of a valid format.
This field is required.
This field is required.
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If you selected Urgent, call 911 before you complete this form
This field is required.
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Use the date of your last observation
This field is required.

Tell Us Who You Are Concerned About:

Involved party 1

Information About the Concern

This field is required.
This field is required.
Concerns(Required)
You must make at least one selection.
Have you talked to or corresponded with this student about your concern?(Required)
This field is required.
This field is required.
This field is required.
Does the student of concern have a trusting relationship with at least one person (e.g. friend, parent, instructor, advisor, coach, staff)?(Required)
This field is required.
This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Select copy recipients

If the student will be missing classes, please check the Academic Dean's office. If this is concerning the illness or death of a loved one, please check Campus Ministry.
If the student will be missing classes, please check the Academic Dean's office. If this is concerning the illness or death of a loved one, please check Campus Ministry.

Submission