CARE Team Reporting Form
P: (212) 650-8222 E:

Use this form to report troubling student behavior of concern that you may be aware of. If you feel that a student or others could be in immediate danger, including yourself, please contact the Office of Public Safety and Security at (212) 650-7777.
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Student’s First Name *
Last Name *
Incident Location *
Incident Date *
Completed By *
Email *
Department *
Cell Phone *
Office Phone *
Date Form Completed *
Part 1: What is this concern regarding? *
(check all that apply)
Part 2: Describe the behavior or incident
Part 3: Are there any effects/impacts of the behavior?
Part 4: Have you made any attempts to address the behavior? How did the individual respond to the attempt?
Part 5: Do you have any other information about the individual that might be relevant?
Part 6: What is the purpose of this report?
Clear selection
Part 7: Any additional information
Clear form
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