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Submit a Student Concern

Thank you very much for your strong commitment to students' success and well-being. Your referral helps ensure that we are truly living our values of care for the whole person and academic excellence.

IN SITUATIONS OF IMMINENT THREAT OF HARM TO SELF OR OTHERS, PLEASE CALL PUBLIC SAFETY AT (206) 296-5911 (First Hill) or (206) 726-5038 (South Lake Union). This form is not monitored 24/7.

How to Use this Form
To start your referral, select the Campus Location. Select your Concern Type. You will be able to share additional concerns in your referral.

What Happens When I Submit this Form?
Depending on the concerns listed, your referral will either be sent to the Office of the Dean of Students or the Student Success Division and an appropriate action will be taken within 3-5 business days.

First Hill Faculty can review updates on their submissions through the My Alerts tab of the Faculty Portal.

Your referral will not generate an automated e-mail to the student(s) of concern. Students are welcome to use this form.

THIS IS AN ABBREVIATED FORM INTENDED FOR USE BY INTERNAL PARTNERS FOR SUBMISSION OF ACADEMIC ALERTS.

PLEASE SHARE ALL RELEVANT INFORMATION IN THE CONCERN DETAILS BOX BELOW. THE STUDENT SUCCESS DIVISION WILL TURN THESE DETAILS INTO AN ACADEMIC ALERT CASE.

INTERNAL: Faculty Portal Default Campus - Student Campus Location

This Early Alert is related to the following course:

Campus

Student Campus Location

Concern Details

Select Concern Type

Is part of your concern related to the student's attendance?

Yes

Do you have any specific information or has the student disclosed personal experiences that would indicate a concern for the student’s wellbeing or safety that is affecting their attendance? For example: loss of a family member, history of depression or suicide, chronic or acute medical illness, etc.

Yes

Due to the student's campus location, you will be asked to submit additional details on the next screen through the Cornish Student Support Request & Academic Early Alert Referral form.

Click "Submit" to continue.

Due to the nature of this concern, you will be asked to submit additional details on the next screen through the CARE Team Referral.

Click "Submit" to continue.

Please provide a summary of your concerns, and any actions you have already taken to support the student.

Does this concern relate to a specific course?

Yes

Course Section:
*Search by term followed by course number*

Do you wish to report any additional concerns?

Yes

Additional Concern Details

DeleteStudent _ID_
Student Details
Student Name Student SU Email Student SUID If known Have you spoken with this student about your concern(s)? If you have, please include any relevant information in the narrative space above Have you spoken with this student about your concern(s)? If you have, please include any relevant information in the narrative space above Yes No I am the student of concern HIDDEN: Student Names

Add Another Student

Reporter Information

Other Reporter Type

Your First Name

Your Last Name

Your SUID

Your Email Address

Your SU Email Address