CARE Referral

This form is used to express concerns related to a Baker College student, staff, or faculty. The form is submitted directly to the Campus Assessment, Response, and Education (CARE) Team.
This form is used to express concerns related to a Baker College student, staff, or faculty. The form is submitted directly to the Campus Assessment, Response, and Education (CARE) Team.
For student concerns, the CARE Team facilitates communication, assists in developing strategic interventions, and coordinates the management of ongoing or recurring issues. The ultimate goal is to prevent conflicts and high-risk behaviors from escalating into emergencies.
For faculty and staff concerns, the report is turned over to Baker College’s Human Resources for information gathering and follow-up.
Reports are submitted confidentially.
Please be aware that this form is reviewed during normal business hours. It is not monitored after hours, on weekends, or on College holidays.

If there is a life or death emergency, dial 911 immediately!
Categories of Concern

Behavioral
  • Concerning use of alcohol or drugs
  • Written or verbal expression of morbid, dark, or violent thoughts
  • Potentially risky behaviors (restricted eating, excessive exercising, binging/purging, misuse of medications, etc.)
  • Self-harm behaviors (cutting, scratching, etc.)
  • Disruptive behavior
  • Sudden change in mood or demeanor


Social/Emotional

  • Depressed state or anxiety beyond what seems normal    
  • Loss of a friend or family member    
  • Physical or domestic violence
  • Sexual assault or sexual abuse    
  • Thoughts or threats of suicide    
  • Financial issues    
  • Anxiety about coursework or in response to grades
The Individual you are concerned about
Please note "N/A" or "unsure" if you do not know their name.
Individual Residency Status
Individual Residency Status
Select Role
Select Role
Describe the Situation(s)
Please note how long the behavior(s) have been occurring and any specific threat and/or upcoming event, meeting time, or class for which you are particularly concerned
Would you be willing to talk to a member of the CARE team?
If you have shared your name, email, and/or phone number, and the CARE Team has any questions, do you give permission to be contacted?
Would you be willing to talk to a member of the CARE team?
Photos, video, email, and other supporting documents may be attached below. If you have multiple files please click on Browse, locate the files on your drive, click on the first file, hold down the ctrl key on your keyboard and select the remaining files before clicking on Open.
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Other Fields

Your name
Verification Code