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Referral for Student Support


Use this form to refer UNC students to Student Outreach & Support within the Dean of Students Office. By completing this form, students and their support systems (family, friends, faculty, staff) help us to connect students in distress with valuable information about relevant resources and timely assistance from our case management team.

Our team reviews referral forms during business hours (form submissions are not monitored after hours, on weekends, or during official university holidays).

IF THIS IS AN EMERGENCY PLEASE CALL 911 OR CAMPUS PD AT 970-351-2245

Following a referral, our team will respond directly to the student with information about relevant resources and recommended next steps.

If you have questions about the form or filling out this form please contact the Dean of Students Office at (970) 351-2001.

Your Information (Who is making the referral?)

All referrals are treated with discretion. Information from this form may be shared with appropriate individuals to help protect the health and safety of those in our community. You may remain anonymous when completing this form; however, having your name and contact information is helpful in case there is a need to obtain more information about or clarify the situation. Every attempt will be made to review and address the concerns you submit on this form, but without adequate information, the university may not be able to respond as effectively; therefore, your contact information is strongly encouraged.

 
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Individuals Involved

Please provide as much of the requested information as you are able so that we can accurately identify and efficiently connect with this student involved to provide support.
If information is known about others involved and/or directly impacted, please include their information below.

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Reason for Referral (What are your concerns for this student?)

Please answer the questions to the best of your ability or knowledge.

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What is the nature of your concerns for this student?(Required)
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Please indicate any other agencies or campus offices that were involved in assessing/addressing this student’s concern.(Required)
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Is the student aware that you are making this referral?(Required)
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If there is an immediate risk of harm to self or others, please contact UNC Police at 970-351-2245 prior to submitting this form. I understand that referrals from this form will be received during normal business hours (M-F, 8AM - 5 PM) and are not monitored after hours, on weekends, or during official University holidays.(Required)
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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