Refer a Student

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Refer a Student

Thank you for sharing your concerns for a student at the University of Illinois, Urbana-Champaign.

BEFORE YOU BEGIN: If this is an emergency that involves an imminent risk of harm to self or others, please contact campus police at (217) 333-1216 or by dialing 911 BEFORE filling out this referral form. Referrals are reviewed during normal business hours and are not monitored after hours, on weekends, or during official University holidays. Although referrals from this form are reviewed by a variety of campus partners working to assist students, it is NOT designed for emergency response situations.

Tell us about you:

 

 

answer must be phone number with area code like 217-333-1000

 

answer must be an email address

 

Tell us about who you are concerned about:

Please list the individuals involved, including as many of the listed fields as you can provide.

 

 

answer must be a university ID like 612345678

 

Tell us about your concerns:

answer must be date like mm/dd/yyyy

 

 

 

Based on the description you provided, please check any behaviors below that have led you to be concerned about the individual involved:

Based on the description you provided, please check any behaviors below that have led you to be concerned about the individual involved:

Please indicate if any of the following actions were taken as a result of the concerns you have described:

Please indicate if any of the following actions were taken as a result of the concerns you have described:

requiredI understand that referrals from this form will be received during normal business hours (Mondy-Friday, 8:30 am-5:00 pm and are not monitored after hours, on weekends, or during official university holidays. Please contact University police at (217) 333-1216 if there is an immediate risk of harm to self for others prior to submitting this form.

requiredI understand that referrals from this form will be received during normal business hours (Mondy-Friday, 8:30 am-5:00 pm and are not monitored after hours, on weekends, or during official university holidays. Please contact University police at (217) 333-1216 if there is an immediate risk of harm to self for others prior to submitting this form.

Supporting documentation:

Photos, video, email, and other supporting documents may be attached below.

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