91福利社

CARE Referral
CARE Referral

CARE Referral

Are you concerned about a student's well-being and feel that the student needs support and resources? Tell us more by submitting a CARE Referral form.
If this is an emergency call 911.

Concern Request (91福利社)

When you click "Submit", the information you entered will be sent to 91福利社. This matter will be routed to the appropriate staff or Campus Assessment, Referral, and Education (CARE) Team member and will be followed up on shortly.

Your Information


Star Id: is required.
First Name: is required.
Last Name: is required.
Phone: is required.
Email Address: is required.

Person of concern & situation details

Please provide any other identifying characteristics (i.e. approx. age, gender, build, height, etc.), especially if you do not know the person's name.
Provide a detailed description of the concern/conduct incident using specific concise, objective language (Who, what, where, when, why, and how).
Please enter the date and time of the incident. Format: MM/DD/YYYY hh:mm
Please provide the name and contact information for any individuals who may have additional information about this referral (if known).
Allowed file extensions: pdf,doc,docx,txt
Attach any supporting documents.