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Care Team Referral Form

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If you need to report an emergency, do not use this form. Contact Campus Security at (808) 974-7911. If you are reporting suspicious activity or a crime and wish to do so anonymously, please refer to the Silent Witness Program.

Under Title IX/VAWA, Hawai╩╗i State Law, and UH System policy EP 1.204, UH Hilo faculty and staff members are designated as ÔÇťresponsible employees.ÔÇŁ This means that if a student, faculty, or staff member reports an incident of sexual misconduct to you, you are required to report it to the Title IX Coordinator. More information can be found at the Title IX website.

Referring a Student of Concern to the Care Team

Anyone may use this form to refer a UH Hilo student to the University's Care Team. All matters discussed by the Care Team are regarded as highly confidential and are protected by the Federal Educational Rights and Privacy Act (FERPA).

If you have any questions about filing a report, please contact the Care Team Coordinator at (808) 932-7472.

File a New Report

Reporter’s Information (optional)

When submitting this report, please include as many details as possible including your name, title, and contact information. Please note that submitting the report anonymously may greatly limit the institutionÔÇÖs ability to address your concern. The CARE Team may need to contact you if additional information is needed.

Incident Details (optional)

Please fill in as much information as you can.

(MM/DD/YYYY)

(be as specific as possible, including: room number, course number, street address, etc.)

Reason(s) for Report (required)

Academic

Physical/Emotional/Social

Behavioral

(please describe below)

Please provide a detailed account of behaviors or concerns prompting this report. Include dates when possible.

How can the Care Team best assist you with this concern? (required)

Check all that apply

  • (please indicate college below)

If you have supporting files to attach to this report, please upload them below

Upload supporting files (optional)

Quiz (required)

You appear to be submitting this form from off-campus. Please answer this simple quiz.