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Dean of Students - Student of Concern Form


Below is brief guidance for students, faculty, or staff wanting to share a concern about an individual student or students and their well-being. This form invites you to share as much detailed information as you can involving a student who you are concerned about. For additional detail, please read the guidance on our website about how to get support.

Emergencies and Urgent Concerns

For all emergencies, please call 9-1-1 or contact Stanford Department of Public Safety at 650-329-2413.

The form below is for non-urgent and non-emergency referrals. If you have an urgent concern and would like to consult with an on-call staff member, please consult the following instructions:

- Undergraduate Students - Call the Resident Director On-Call at 650-504-8022.
- Graduate Students - Call the Graduate Life Office (GLO) Dean On-Call pager at 650-723-7288 (provide pager ID #25085). You can also text the GLO pager at 25085@pageme.stanford.edu. Include your name, your return phone number and reason for paging in the message.

Additional Information and Other Options

Referrals filed through this online form are immediately received through this system. Once this form is received, a university staff member will review the incident and may follow up to gather additional information and discuss a plan of action.

Student records, including referrals using this form, are protected by FERPA (Family Educational Rights and Privacy Act), and therefore the disclsoure of some information regarding the outcome of this process may require the consent of the student(s) involved.

You may use the form below to share a Title IX incident with the SHARE Title IX Office and the Dean of Students Office. However, if you would like to share information only with SHARE Title IX, please use this form instead.

If you have any questions regarding sharing a concern, please contact the Dean of Students Office (650-723-2733) or send an email to deanofstudents@stanford.edu.

Concerned Person Information

 
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If you are a Stanford faculty/staff, please share the full name of the unit where you work.
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Please choose an option that describes the most significant concern you are sharing.
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Please choose an option that describes your level of concern about this referral.
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Student(s) of Concern

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Description of event

Involved Parties: Please list any involved parties, as well as their SUID numbers and/or other contact information. You do not need to repeat information already provided above under "Students of Concern".

Description/Narrative: WHO, WHAT, WHEN, WHERE, WHY, and/or HOW: Please describe in as much detail as possible the specific concern or incident that occurred. Avoid using pronouns, i.e., he, she, etc. to identify people. When known, use the person's real name in your description; otherwise give the name you know the person by. Indicate specific words, phrases, interactions, and behavior. Give dates and times. If a person used profanity, made threats, or spoke of harming themself, indicate specific words/phrases used. If a student was loud or disruptive, indicate behaviors associated with the disruption, and describe any injury or damage to person(s) or property. If this is a student behavioral or emotional concern, please describe the student's behavior that has prompted this report.

Action(s) Taken: Please describe any actions that were taken to follow up on this concern, including name(s) of campus personnel or other departments you contacted.

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Supporting Documentation

If your attachment size exceeds 5GB, please contact the Dean of Student's Office (deanofstudents@stanford.edu) to make arrangements for submission. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Notify Additional Staff or Departments

Select below if you want this form submission to automatically notify either the Title IX Office, Graduate Life Office (for graduate students), and/or an undergraduate student's Resident Director (RD) and Neighborhood Program Director (NPD).
Select below if you want this form submission to automatically notify either the Title IX Office, Graduate Life Office (for graduate students), and/or an undergraduate student's Resident Director (RD) and Neighborhood Program Director (NPD).

Submission