Staff Referral - Hawk Line

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Do you have a student that needs a COC or counselor check?

Email *

Record my email address with my response

Referring Staff Member *

First Name of Student *

Last Name of Student *

Grade *

1st

2nd

3rd

4th

5th

6th

7th

8th

On a scale of 1-3, how urgent is the need?
*

1: It can wait until someone is available.

2: I would like them to meet with someone at some point this week

3: It's urgent; please see them as soon as possible

If you answered 3 above, please select from the following: *

They are deeply struggling (Might not be safe from hurting themselves or someone else)

They are having a panic attack or about to cry. This cannot wait for tomorrow.

There is trouble brewing within a group.

None of the above, my concern can wait for another time this week.

Required

Have you already talked to anyone on campus about it? *

Yes

If you marked "Yes" above, who have you talked to? Is there new information to be shared?

Please give some additional information about what is going on. *

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