CARE Form

If this is an emergency and you need to report an imminent threat or life-endangering situation involving a student, please immediately call 9-1-1 or JU Campus Security at (904) 256-7585. The CARE Form is not designed as an emergency response notification process.

Student of Concern
Student's name Student's name * First Last
Student's JU ID number
Student's phone number Student's phone number - ### - ### ####
Student's email
Are you an active or retired Military? *

Are you an active or retired Military? Yes No
Background Information
Would you like to report anonymously? Please note that submitting this form anonymously may limit the University’s ability to respond. *

Would you like to report anonymously? Please note that submitting this form anonymously may limit the University’s ability to respond. Yes No
Reporter's name Reporter's name First Last
Reporter’s position / title / relationship
Reporter's phone number Reporter's phone number - ### - ### ####
Reporter's email
Reporter's relationship to student
Nature of concern

Nature of concern Change in behavior Death or serious illness of family member or friend Disturbing behavior Sexual misconduct Health risk Mental health Substance use/abuse Other Other

Check all that apply.
Description

Why are you concerned? Include date/time of incident.
Have you or others addressed the concern(s) with the student?

Have you or others addressed the concern(s) with the student? Yes No
If yes, please describe the interaction(s) and mention any referrals offered to the student.
Why are you filling out this report?

Why are you filling out this report? This is for informational purposes only. Student needs immediate follow-up. Students needs ongoing support. Providing update on previous report. I would like advice on how to interact with or support the student. I am not sure.
Is the student aware the Students of Concern team is being notified on their behalf?

Is the student aware the Students of Concern team is being notified on their behalf? Yes No
Supporting documentation

Attach Files

If applicable, please upload any relevant supporting documentation.

CARE Form

CARE Form

Student of Concern

Background Information