Student Life

A strong community
Builds strong futures

Because We Care ...

becausewecare.jpgWe are asking you to help identify students about whom you have a concern.  When problems persist in spite of your involvement, submit this form to Gerrie Paino, Coordinator for Student Services Initiatives, x2111.  She and other professionals will work to resolve the student problem.  This form is not seen as a substitute for continual conversation, nor will it become a record for the judicial system.

You'll be notified of receipt of the form and disposition of the concern when appropriate.

Student Name:
Today's Date:
Faculty/Staff Name:
Your Phone Extension:
Relationship to Student:

I am concerned because this student has:
(Check all that apply)
Regularly missed class
Performed below expectations
Not been seen in a number of days
Talked about leaving BW
Been uncharacteristically inattentive/unresponsive
Had significant behavioral or mood/attitude/appearance changes

Other comments:


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