Indiana University Logo

IU Indianapolis - Care & Support Referral


BEFORE YOU BEGIN: If this is an emergency that involves an imminent risk of harm to self or others, please contact campus police at 317-274-7911 or by dialing 911 prior to filling out this referral form. 

This referral form is designed to to request support for oneself or a student who is experiencing concerns that are impacting their success, and/or whose behavior is concerning, worrisome, or threatening.

Please note that referrals are reviewed during normal business hours and are not monitored after-hours, on weekends, or during official University holidays. While referrals from this form are reviewed by a variety of campus partners working to assist students and employees, it is NOT designed for emergency response situations. If the information in the referral is determined to be emergency-related, law enforcement may become involved to check on the immediate well-being of our student.

For assistance or consultation during business hours while completing this referral, please contact the Office of the Dean of Students at 317-274-4431.

 

Please note, the Office of the Dean of Students is not a confidential resource. Staff are required to report any disclosure related to harm to self or others, sexual misconduct, abuse of a child or endangered adult, or crime that occurs on or around campus. 

If you are seeking confidential support for concerns related to sexual harassment, sexual violence, or relationship violence, please contact the Confidential Advocate  at saadv@iu.edu  or 317-274-5715.  

If you are seeking confidential mental health support, please contact Counseling and Psychological Services (CAPS)  at capsindy@iu.edu  or 317-274-2548. 

 

This referral form is intended to request support for students, faculty, or staff at IU Indianapolis. If you are seeking to submit a referral for a Purdue University in Indianapolis student, please complete the Purdue University Student of Concern referral form. 

 

 

 

Background Information

 
Enable additional features by logging in. 
Learn more
Your relationship to the individual (i.e. self, parent/family member, peer, advisor, faculty, etc.)
Email address must be of a valid format.
This field is required.

Tell Us Who Needs Assistance:

Please list the individuals seeking/in need of assistance, including as many of the listed fields as you can provide. 

Involved party 1

Tell Us About Your Concerns

Nature of Concern - please select all that apply(Required)
You must make at least one selection.
This field is required.
Observations of Appearance or Behavior
You must make at least one selection.
General Observations
You must make at least one selection.
Concerns Reported or Known to You
You must make at least one selection.
Is the student aware a referral is being submitted on their behalf?(Required)
This field is required.
Has IUPD been contacted regarding this concern?
This field is required.
I understand that I may be contacted for further details and that referrals from this form may be forwarded to University offices/officials as appropriate to address the concern.(Required)
You must make at least one selection.
I understand that referrals from this form will be received during normal business hours (Monday - Friday, 9AM - 5PM) and are not monitored after hours, on weekends or during official University holidays. If this is an emergency or you need immediate assistance, contact the Indiana University Police Department at 317-274-7911.(Required)
You must make at least one selection.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission