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I am concerned about a student...


Please use this form to notify the Offices of Student Affairs and Counseling Services of your concerns about a student.

Please fill out all information in the fields below completely before submitting. ( Fields marked with * are required )

Today's Date:
* Faculty/Staff Name:
* Phone Extension:

Relationship to Student:
Class Professor
Advisor
Supervisor
Other:   

* Student's Full Name:
* Student's College ID Number:

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

Comments:

To adequately address your concern, we would like to share your name with this student.  However, we do respect your confidentiality, thus if you wish to remain anonymous please let us know.

Please click Submit to send this form to Crystal Lynn, Assistant Dean of Students. The Offices of Student Affairs and Counseling Services will make every effort to address your concern and assist the student.  Thank you.