Students.sunyocc.edu

We Care - Case Collaboration Committee Referral Form

Members of the Onondaga community may refer students whose behavior is of concern to the Case Collaboration Committee via this form. Remember, immediate concerns requiring immediate action need to be referred to Campus Safety and Security.

Student Information

Term:  Fall Spring Summer  

Year:    

Student Name:   

Phone number (if known):   

Email (if known):   

What is the best way to contact the student?   Phone Email  

Report

The Department of Student Services seeks your help in identifying Onondaga students who are in need of guidance and support. The purpose of this report is for you to be able to alert us of students whose actions and behaviors are causing concern. This report will be utilized to provide assistance to the student. If you believe the student or the community is in immediate danger, please contact the OCC Campus Safety and Security office at (315) 498-2311.

Actions and Behaviors:

Have others shared with you they are also concerned about this student?   Yes No  

Please comment on the concerning behavior:

What, if anything have you done to address this concern?

Do you wish to remain anonymous to the student?  Yes No  

(If you wish to remain anonymous, the chairperson of the team may still contact you for further information)

Your Name:   

Your Email:   

Your Phone:   

Evidence to suggest false or misleading reports with intent to defame the character of another, may result in disciplinary actions.