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CARE Team Reporting Form


Thank you for taking the time to let us know about your concerns for our USI community member.

This email is not monitored 24/7.

If you are reporting a student whom you think might need immediate attention (i.e. a student presenting harm to self or others) please call Public Safety 812 492 7777. They can assist all students.  If there is a safety concern for the student or any USI community member, please contact Public Safety.  They can evaluate and triage situations quickly.  

If this report could fall under our Civil Rights and Sexual Misconduct policy (Title IX), please use the report found on this page www.usi.edu/stopsexualassault

CARE team reports are part of a student's educational record and therefore fall under FERPA protections which include releasing reports when a student requests a copy of the report.  

Reporter

If you are filling the report for yourself please list your name in the reporter's name field and your affiliation. Then you can SKIP to the NATURE OF CONCERN. The other contact information will be collected in the INVOLVED PARTIES section.

 
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Involved Parties

Please list the student(s) involved, including as many of the listed fields as you can provide. For non-students, please list any ID information available. Please select 'Add another person' for anyone else who may be willing to speak with the CARE Team about similar concerns.

Involved party 1

Areas of Concern

Please check all of the boxes that apply and provide a description of the incident(s) or student contact in the provided space. Then answer the questions to the best of your ability, objectively as possible.

ACADEMIC
You must make at least one selection.
GENERAL
You must make at least one selection.
BEHAVIORAL
You must make at least one selection.
This field is required.
Do you/they have any academic concerns related to online instruction? This includes concerns or issue with technology (equipment) or access to the internet.
This field is required.
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Have you connected with the student about your concerns?(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission