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UNL Student Concern Form


This reporting form should not be used to report emergencies. If you feel threatened, or are aware that someone is in extreme distress or at risk for harming themselves or others, please dial 911 immediately.

This form should be used to report non-emergency concerns about student well-being. The information you provide will be reviewed by the Office of Student Advocacy and Support and may be shared to the UNL Behavioral Intervention Team (BIT). BIT provides a proactive, supportive, and coordinated response to student behaviors that may compromise the safety and well-being of the student and/or others.

Information submitted through this form constitutes an educational record and may be inspected by the student(s) identified in the report. If you have questions or would like to discuss your report before submitting it, please contact Student Advocacy & Support.

Student Advocacy & Support

(402) 472-0878

studentadvocacy@unl.edu

205 Louise Pound Hall

Background Information

Please provide us with your identity and contact information. Although providing your name and contact information is not required, sharing it will allow BIT to follow up with you to clarify anything that is unclear from your report.

 
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Email address must be of a valid format.
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Individuals Involved

Please list the individuals involved (excluding yourself), and provide as much information about the individuals involved as you can.

Involved party 1

Questions

Please answer all questions as thoroughly and truthfully as you are able.

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Based on the description you provided, please check any behaviors below that have led you to be concerned about the individual involved:(Required)
You must make at least one selection.
This field is required.
Please indicate if any of the following actions were taken as a result of the concerns you have described:(Required)
You must make at least one selection.
Have you talked to or corresponded with this student about your concern?(Required)
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Does the student know this report was being made?(Required)
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I understand that referrals from this form will be received during normal business hours (Monday-Friday, 8:00 am-5:00 pm) and are not monitored after hours, on weekends, or during official university holidays. Please contact University police at 402-472-2222 if there is an immediate risk of harm to self or others prior to submitting this form.(Required)
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As possible and within the limits of FERPA, would you like to be updated as to the outcome of this referral?(Required)
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Would you like to remain anonymous or are you ok with a case manager sharing with the student that you communicated this concern? Please note that if you would like to remain anonymous, we do not share that information with the student, however they may be able to piece together information on their own.(Required)
This field is required.

Supporting Documentation

Papers, photos, video, email, copies of websites and other supporting documents that may be relevant to the case can be uploaded here. 1GB maximum total size. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission