CARES Intervention Report of Concern

The CARES Team responds to non-immediate concerns and takes a proactive approach to discuss potential issues, intervene early, and provide support and behavioral response to students displaying varying levels of disruptive, disturbed, and/or distressed behaviors before they rise to the level of a crisis.

Reporting Party's Information

First Name *

Last Name

Date *

What is your role at College of Alameda? *

Email Address *

Phone Number *

Person of Concern Information

First Name

Last Name

Student ID (if you do not have one leave blank)

Threat to self or others *

Select *

Incident Report

Date of incident *

Please provide a detailed description of the incident/concern focusing on fact, including people involved (who, what, when, where, why, and how). *

Do you want to remain anonymous? *YesNo

Please detail any action(s) that you have taken in response to this incident. If no action was taken, then type "none" in the text box below. *

Please submit any supporting documents (email, photos, videos, etc).

No file chosen

Acknowledgement and submission *

I acknowledge that the information I provided in this report is accurate and truthful to the best of my knowledge.

Reporting Party's Information

Incident Report

Acknowledgement and submission *

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