Please note, this form is NOT meant to be used for immediate concerns or emergencies (please refer to the previous page for emergency resources). This form is also ONLY for referring current Herberger Institute for Design and Arts students. If you are concerned about a student in another ASU college, please contact ASU Student Rights and Responsibilities at 480-965-6547.
Please fill out the following form to the best of your knowledge.
Moderate Concern - Concerns in which there is low to medium impact to a student’s life and wellbeing with uncertain consequences.
Significant Concern - Concerns in which there is medium to high impact to a student’s life and wellbeing with direct consequences.
Serious Concern - Concerns in which there is high and certain impact to a student’s life and wellbeing with severe consequences or harm.
Social/Personal - Student needs to develop personal connections with peers, staff, or faculty for a sense of belonging. Examples of a concern in this area is homesickness, isolation, or lack of engagement.
Emotional/Behavioral/Wellbeing - Student shows symptoms of depression, anxiety, or other emotional states that may inhibit their ability to succeed as a student or overall wellbeing. Examples of a concern in this area is a student acting disruptively in a classroom, disengaging from activities, or anxiety about their future.
Health/Illness/Injury - Student experiences issues in areas of health, injury, or illness. Examples of a concern in this area is a sudden injury, lack of balance in school life affecting health, or lack of sleep impacting their ability to be a successful student. .
Financial - Student expresses concern over their ability to cover tuition or basic living costs in the immediate future. Example of a concern in this area is a student divulging that they have a significant account balance that prevents them from registering for class or retaining to the institution.