Student Concern Notification Form

Please use this form to notify us of any student you have identified with emotional, social, or behavior concerns. Your personal information is not required but may be helpful if the CARE team needs more information. If you believe that the student is in eminent danger of harming himself/herself or others, please immediately dial 911 or notify the Security Office immediately at (435) 222-1300 (Utah campus) or (720) 875-2892 (Colorado campus). Thank you for your concern and sharing this information.

At which campus does the student attend RVU?*
- Colorado
- Utah
- Montana
Student of concern:*
First Last
Please describe your concern:*
May we contact you for additional information or clarification?*
- Yes
- No
Please provide your contact information.
Your name (optional):
First Last
Your e-mail address (optional):
Your cell phone number (optional):

Please provide your contact information.