Care Team Referral Form

All fields marked with * are required.

Reporting Party — Your Information

Submitting an anonymous concern inhibits the college’s ability to fully investigate and assist students of concern. We ask you to complete all fields to the best of your knowledge.

Incident Information

Location of Incident

Students of Concern and Involved Parties

You can submit up to three students per form. If more students were involved, please submit another form.

Student 1: Role
Student 1: Is this student aware you are concerned about them?
Student 2: Role
Student 2: Is this student aware you are concerned about them?
Student 3: Role
Student 3: Is this student aware you are concerned about them?

Contact Information

The Care Team

Student Care Coordinator

Sarah Kenkel
Student Services
Hawkeye Center 208
319-296-4053
Email Sarah Kenkel

Dean of Students

Nancy Henderson
Student Services
Hawkeye Center 208
319-296-4448
Email Nancy Henderson

Back to top