AU Cares Student of Concern Form
Use this form to submit student behavior concerns and/or to report an incident. **The CARE Team is not tasked with responding to emergencies. If this is an emergency and you are in need of immediate assistance or consultation, contact Campus Safety at 864-231-2060.
Your full name:
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Your position/title:
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Your phone number:
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Your email address:
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Your physical address:
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Name of Student of Concern
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Student's Gender
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Please Select
====[Select Gender]====
Male
Female
Student's ID Number (if known)
Student's Year
Student's Birth Date (if known)
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Student's Phone Number (if known)
Student's Email Address (if known)
Student's Residence Hall Assignment (if known)
Is this report a result of a specific incident or occurrence?
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Yes
No
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Specifics Regarding Incident
If you are submitting this report as the result of a specific incident please provide a details to enable the best follow up.
Choose the date and time of this incident
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Day
Year
Date Picker Icon
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AM/PM Option
Specific location of the incident:
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Please provide a detailed description of the incident using specific concise, objective language.
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Indicators of Student Distress
Please provide information about signs you have noticed that indicate this is a student of concern. You may check any that apply.
Academic Indicators
Repeated absences from class, section, or lab
Missed assignments, exams, or appointments
Deterioration in quality or quantity of work
Extreme disorganization or erratic performance
Written or artistic expression of unusual violence, morbidity, social isolation, despair, or confusion
Continual seeking of special provisions (extensions on papers, make-up exams)
Patterns of perfectionism: e.g. can't accept themselves if they don't get an A+
Overblown or disproportionate response to grades or other evaluations
Essays or papers that focus on suicide
Behavioral & Emotional Indicators
Direct statements indicating distress, family problems, or loss
Angry or hostile outbursts, yelling, or aggressive comments
More withdrawn or more animated than usual
Expressions of hopelessness or worthlessness; crying or tearfulness
Expressions of severe anxiety or irritability
Excessively demanding or dependent behavior
Lack of response to outreach from course instructor
Shakiness, tremors, fidgeting, or pacing
Sudden change in behavior
Physical Indicators
Deterioration in physical appearance or personal hygiene
Excessive fatigue, exhaustion; falling asleep in class repeatedly
Visible changes in weight; statements about change in appetite or sleep
Noticeable cuts, bruises, or burns
Frequent or chronic illness
Disorganized speech, rapid or slurred speech; confusion
Unusual inability to make eye contact
Coming to class bleary-eyed or smelling of alcohol
Other Factors
Concern about a student by his/her peers or teaching assistant
A hunch or gut-level reaction that something is wrong
Absence from on campus housing for multiple days without expla
Please provide any additional information regarding this student you feel would assist the AU Care team in providing support to this student and addressing the concerns.
Attach additional supporting documentation (i.e. copies of any email or social media communication showing the reason for concern)
Enter the message as it's shown
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Submit report
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