Student of Concern Reporting Form

 

In the event of an EMERGENCY, please do not use this form. Call LSUE Police (337-550-1225) or call 911.

 

The Office of the Dean of Student Affairs provides staff support for the LSUE C.A.R.E. Team, which is an important asset to the LSUE community.  By completing this form, you will be sharing your concern with LSUE staff members who are trained in responding to student needs.  Thank you for sharing your concerns and making a difference in the LSUE community.

Disclaimer: Upon completion and submission, this form or inform nnotheratiein may constitute an educational record of any student(s) referenced, and is protected from disclosure except in some limited circumstances. As an educational record of a student, that student may have a right to review the form. The University will endeavor to maintain the information contained in the form as private, to the extent required by the law. Questions regarding this form and its completion or use should be addressed to studentaffairs@lsue.edu.

If there is a possibility that a student may harm themselves or others, dial 911 immediately. This form should NOT be used to report emergencies.

 

You may submit this report anonymously. However providing your identity will be helpful in the event the C.A.R.E. Team needs to follow up, receive additional information, etc.
Please select which most accurately describes you.
Is there a specific incident associated with this report?
In other words, was there a specific occurrence that led to this report or is it a more general concern or series of issues?
STUDENT(S) OF CONCERN INFORMATION:

Please provide as much information as possible regarding the student you are referring.
Please provide the student's full name and student ID number for each student you are reporting on. If you are reporting on more than one student, list each student and ID number on separate lines.
Additional Information and Questions
I understand that this form must NOT be used to report emergencies, including situations in which students may be a threat to themselves or others.
Please identify any concerns or needs for students in CRISIS, DISTRESS, or EXHIBITING CONCERNING BEHAVIOR.
Check all that apply.
Please provide as much detail as you can about the concern or behavior you are reporting. Include timeline of events and the full names of all parties involved, if applicable.
Have you addressed these concerns with the student?
Is the student aware of this referral?
If you have any pictures or other documentation that can supplement this report, please email those pictures or documents to studentaffairs@lsue.edu.