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CARE/Student of Concern Reporting Form


This form is intended to encourage faculty, staff, students, and community members to report concerning or threatening behavior of campus community members. The CARE Team will review the report and determine the best course of action to support the campus community member and intervene before behavior escalates. If you see something, know something, or sense something of concern, please complete this form.

Please note that submissions using this form might not be reviewed outside of normal business hours. If there is an immediate risk to health or safety, contact University Police at (510) 885-3333 or by dialing 9-1-1.

Background Information

Please provide as much information as possible so that the CARE Team can provide the best care for the student. A member of the CARE Team may follow-up with the reporter if additional information is needed.

 
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First and Last
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Student, Faculty, Staff, Alumni, Community Member
This field is required.
This field is required.
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room #, parking lot letter, specific description

Involved Parties

List the names of all individuals involved and include as many fields as you can provide.

Involved party 1

Information Regarding Concern

I am concerned about the following behaviors (check all that apply):(Required)
You must make at least one selection.
This field is required.
This field is required.
This field is required.
This field is required.

Supporting Documentation

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

Submission