EmailMe Form - Behavioral or CARE Team Referral

BEFORE COMPLETING THIS REPORT, PLEASE READ:

Selecting the correct response below for "Nature of Referral" is vital to ensure prompt attention by the appropriate resource areas. If you believe a crime is being or has been committed, or if your or someone's safety is immediately threatened, please call 911 or ABAC Police at 229-391-5060.

When selecting the "Nature of Report" below, select "CARE Team Referral" if you or someone you know is experiencing and may need help with personal struggles, including but not limited to thoughts of self-harm, mental or physical health concerns, erratic or threatening behavior, or other challenges of a personal nature.

Or, when selecting "Nature of Referral" below, select "Non-Academic Misconduct (Behavioral)" if you are reporting that someone has taken actions or exhibited behaviors that may have violated the student conduct code.

Or, when selecting "Nature of Referral" below, select "Academic Misconduct (Student Submission)" if you believe someone has violated academic standards by cheating or enabling cheating in academic work. Faculty must fill out the Academic Misconduct Report.

BACKGROUND INFORMATION

Your full name:

First Last

Your status:

Your phone number:

### - ### - ####

Your email address:

Nature of Referral: *

Please see important note at top of form.

Urgency of this referral: *

Date of incident: *

MM / DD / YYYY

Time of incident:

HH : MM AM/PM

Location of incident: *

Specific location:

Who Are You Referring?

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

Name of Person

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

Was there anyone else involved?

Name of Person

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

Do you need to include another person?

Name or Organization

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

Add another party (3)

Name or Organization

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

Do you need to include another person? (2)

Name or Organization

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

QUESTIONS

Please select which categories pertain to the incident.

General Behavior

Health & Safety

Academic Misconduct (Student Report)

Academic integrity,

Excessive assistance,

Obtaining or furnishing exam questions or answers,

Plagiarism,

Taking or attempting to take class materials or equipment,

Questionable tutoring and academic irregularity,

Unauthorized examination materials.

Non-Academic Misconduct

Residence Life

Please provide a detailed description of the incident/concern using specific concise, objective language.

How did you become aware of the incident?

Were you personally threatened?

Did you feel threatened at the time?

Do you currently feel threatened?

Did you see others threatened?

Do you currently feel uncomfortable due to the incident?

Do you think others are uncomfortable due to the incident?

How was the incident terminated?

SUPPORTING DOCUMENTATION

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

Choose file(s) to upload