University of Central Florida Logo

Student of Concern Form


If this is an EMERGENCY or a student needs IMMEDIATE ASSISTANCE, please call the UCF POLICE DEPARTMENT at 911 or 407-823-5555 (non-emergency line). If a UCF student is in distress and needs someone to talk to after hours or on the weekend, please have them call the CAPS Crisis Line at 407-823-2811, press 5 and they will be connected to a licensed therapist. If not, please proceed with the reporting form below. The Student of Concern Reporting Form is NOT designed as an emergency response notification process.

*This report will be reviewed by a University of Central Florida staff member during UCF business hours, Monday-Friday, 8am-5pm.*


Why document? This form allows UCF students, faculty, staff, family members and community partners to refer a student that is experiencing personal or academic challenges impacting their success and well-being. Once a form is submitted, a staff member will review the information and take appropriate action, which may or may not include contacting the student, you, and any witnesses you have identified. Our goal is to connect with the student before a situation reaches crisis level and identify the next best course of action. Please provide detailed information regarding the concern you are reporting.

Confidentiality: We will take reasonable steps to maintain the privacy of those who complete a Student of Concern Report, if requested. If the circumstances don't allow privacy to be maintained, this will be discussed with the person making the referral prior to disclosure to the student if possible. 

Please note: All Student of Concern forms are routed to Student Care Services or Academic Advocacy. If you have any questions, additional updates or concerns, please contact Student Care Services at 407-823-5607 or at caremanager@ucf.edu, or Academic Advocacy at 407-823-2800 or at advocacy@ucf.edu.

Background Information

 
Email address must be of a valid format.
This field is required.
This field is required.
This field is required.

Involved Student Information

Please list the individuals for which you are submitting your concern, including as many of the listed fields as you can provide.

Involved party 1

Information Regarding Concern

This field is required.
I am concerned about the following behaviors (check all that apply):
You must make at least one selection.
Have you addressed the concern directly with the individual?(Required)
This field is required.
This field is required.
Are you aware of any support or services the individual is currently receiving?(Required)
This field is required.
This field is required.
For non-academic concerns, has any police agency been notified? Please be aware that this form is not monitored 24/7. If this is an emergency and you need to report an imminent threat to or life-endangering situation involving a student, please call UCF Police Department at 407-823-5555 or 911 prior to completing this reporting form. The Student of Concern Reporting Form is not designed as an emergency response notification process.(Required)
This field is required.
Is the student aware that this form is being completed?
This field is required.
While we do our best to keep Student of Concern reports confidential, at times it is necessary to identify the reporting party. If necessary, may we share your name with the student?
This field is required.
Acknowledgement: I acknowledge that this form is not monitored 24/7 and should not be used in the case of an emergency or if there is a threat to safety and/or life. I acknowledge that in such instances, UCF Police Department (407-823-5555) or 9-1-1 should be called.(Required)
You must make at least one selection.

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.

Submission