Student Care Form

The purpose of this form is to communicate any concerns that you have may have regarding the overall wellbeing of a PNWCC student. Concerns can be, but are not limited to: academic concerns, missing classes, changes in behavior, personal concerns, emotional concerns, family concerns, etc.
Please know that this form is not monitored 24/7. If this is an emergency, please contact 9-1-1 or suicide & crisis lifeline at 9-8-8 directly. Thank you!

Reporter Information

Your Name:

Relationship to student:

Your telephone number:

Your email address:

Student Of Concern

Name of Student

Reason For Concern

Please provide a description of your concern:

Please rate your level of concern for this student(s):

Please check "yes" to allow the student to see this care form during outreach. Not checking this box will keep the form private. If you have a question on how this form is used in the future, please contact the Dean of Students.

Yes

No

Reporter Information

Student Of Concern

Reason For Concern

Scholarships

Resources

Faculty

Students