Faculty & Staff Request for Student Support (2026-2027)
This form is for CU faculty and staff to elevate student support concerns and connect students with a member of CU’s Community Cares team.

Here are examples of when to use this form to escalate a concern/need for student support:
  • Mental Health concerns
  • Housing instability
  • Incidents of interpersonal, domestic violence, and/ or self harm 
  • Childcare concerns or obtaining basic needs
If you are only looking to report student engagement concerns (such as low - no engagement in class, or assignment completion issues), please use the Engagement Alert form to connect the student with Academic Support.

The Community Cares team will review your referral and connect with the student to advocate and accompany them to community based resources.

If you believe the student is in an immediate crisis, please directly contact Chris Dickson, Assistant Dean of Student Success, at charles.dickson@collegeunbound.edu or text to 404-956-9657 ASAP. 

Email *
Student Name: *
Your name: *
Where is the student located? 
Your relationship to the referred student: 
 *
Describe the issue that you are reaching out about the student: 
 *
On a scale of 1-5, how urgent is this support request?
Low urgency
High urgency
Clear selection
Have you taken any steps to support the student? If so, please list all helpful details: 
When was your last contact with the student?
MM
/
DD
/
YYYY
Anything else you feel like the Cares Team should know: 
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