Student Life CARE Form


Your name:
If you choose to report anonymously, our follow-up on this report may be limited.
Your Email:
Your Phone:
* Your role at Mines:
Administrative Faculty
Faculty
Staff
Student
Other
* Today's Date:
* Name of the Person of Concern:
If the name is unknown, please indicate by typing UNKNOWN in the box.
Campus Wide ID number (if known):
How can the CARE Team best assist you with this concern?
No assistance needed, just an FYI
I would like to receive advice on how to help this individual
I would like the CARE Team to reach out to this individual directly
I am not sure what help is needed
* Description:
Briefly describe your concern (facts, dates, observations, etc.)
What steps have you taken, if any, to address the concern?



* required