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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 at UH Hilo (faculty, staff, or student) may use this form to refer a student to the Care Team. You may be contacted if additional information is needed. 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) 932-7623.

Log in with your UH username and password to refer a student to the Care Team. If you wish to report concerning behavior or a crime anonymously, please submit a Silent Witness report.

Behaviors of Concern

Signs that a student may be in distress and warrant a referral to the Student of Concern may arise in the following ways:

  • Academic
    • Communication that is threating or suggests extreme distress
    • Academic work significantly deteriorates in quality
    • Pattern of missing assignments, appointments, or classes
  • Physical/Emotional/Social
    • Marked deterioration of hygiene, appearance or dress
    • Appearance of intoxication or being under the influence of drugs while in class or other settings
    • References to suicide
  • Behavioral
    • Threats to harm others or angry, or volatile behavior
    • Repeated and/or frequent displays of bizarre or unusual behavior
    • Angry outbursts/crying/extreme levels of disruptive activity or conversations