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CARES Form

Submitter Information

Your Name

Your Email Address

Your Phone Number

Are you okay with the student(s) of concern knowing that you submitted this report?

Yes

Student Information

NOTE: To submit multiple students at one time, click the "Add Another Student" button at the bottom of the form.

DeleteStudent _ID_
Student Information
Is this referral for an online course? Is this referral for an online course? Yes No Student First Student Last Student Phone Number (if known) Student Email (if known) Nature of Concern Nature of Concern Academic Performance or Attendance Behavior (Classroom) Behavior (Outside of Classroom) Mental Health Personal Circumstance Other Academic Performance or Attendance Concerns Academic Performance or Attendance Concerns Excessive Absences Failure to Submit Coursework Lack of Class Participation/Effort Low Score or Failure on Exam Low Score or Failure on Multiple Quizzes Missing Textbook/Course Materials Other Course Name Please describe the behaviors that have prompted you to share your concerns. Please also include any additional details, such as prior steps taken before submitting this concern. Any other context you can share is helpful for our staff. Is this student an athlete? Is this student an athlete? Yes No Unsure Which sport(s)?

Add Another Student

3000 Frederica Street
Owensboro, KY 42301
800-999-0592