Notice of Concern Form

Notice of Concern Form

The Notice of Concern form can be used by any member of the Westmoreland community to refer a student, staff or faculty member who appears to be distressed or is disruptive and may be a cause of concern. Members of the Westmoreland College CARE Team (Campus Assessment, Response, and Evaluation) will review Notice of Concern forms during business hours, Monday through Friday, and will determine the most appropriate action to take.

Please provide as much information as you can. All information provided will remain confidential. A CARE Team member may contact you if there are any questions or if additional information is needed. If, after sending this form, you have more information to share, you may email it to careteam@westmoreland.edu.

If you or another person is in immediate danger or if there is a threat of violent behavior, please contact Campus Security at 724-925-4250 or call 911.  This form should not be used to report emergencies.

Use this form to refer a student

I am...*
Reporter Name*
Reporter Email*
Reporter Phone*
Person of Concern Name
Person of Concern is a...
Person of Concern Email
Person of Concern Phone
Person of Concern Student ID Number
Person of Concern Address
Reason for Concern*Please describe reason for concern (as specific as possible, including dates, times and locations)
Actions Taken*Please describe what actions you have taken, if any
Supporting Documentation
You may select more than one
Request Response from CARE Team?

 

 

Use this form to refer a staff or faculty member

 
I am...*
Reporter Name*
Reporter Email*
Reporter Phone*
Person of Concern Name
Person of Concern is a...
Person of Concern Email
Person of Concern Phone
Person of Concern Address
Reason for Concern*Please describe reason for concern (as specific as possible, including dates, times and locations)
Actions Taken*Please describe what actions you have taken, if any
Supporting Documentation
You may select more than one