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Keuka College Care/Concern Reporting Form


If you need to report an emergency, call Campus Safety at (315) 694-0268, or dial 9-1-1.

Faculty, staff, students, and others may report a student who may be struggling with personal or emotional difficulties, or who may be exhibiting concerning behavior.

Your concern will be received by the Keuka Cares Team (KCT) for review, evaluation, or potential outreach by an appropriate Keuka College official.

While not every field on the following form is required, we appreciate complete information where available.

Referrals made using this form do not violate student privacy rights.

Your Information:

 
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Email address must be of a valid format.
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Student of Concern Information:

Involved party 1

Information About the Concern:

This field is required.
Behavioral, Emotional, Medical, Academic, or Personal concerns for this student. Check any that apply.(Required)
You must make at least one selection.
Have you talked to or corresponded with this student about your concern?(Required)
You must make at least one selection.
Do you wish to remain anonymous if/when this student is contacted?(Required)
You must make at least one selection.

Optional Supporting Documentation:

Photos, video, email, and other supporting documents may be attached below. Maximum 12 megabytes per file. Attachments require time to upload, so please be patient after you click to submit this report. 1GB maximum total size. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission