STUDENT OF CONCERN FORM

STUDENT OF CONCERN

Location*
Please select the campus or location where the student of concern behavior is being observed.
- Greeneville
- Online
Acknowledgement*
I acknowledge that this form is not monitored 24/7 and should not be used in the case of an emergency or if there is a threat to safety and/or life. I acknowledge that in such instances, 911 or Tusculum University Campus Safety should be called.
- Acknowledged
Student Information
Student Name*
Please enter the student's name
First Last
Student ID
Please enter the student's Tusculum ID Number, if you know it.
Student contact information: Sometimes your records my contain contact information for the student that we don't have on file. If you have the student's campus email or phone number for the student, please provide it below.
Phone
Campus Email
Referral Information
Please provide your information below.
Your Name
First Last
Referral Contact Information: Please provide your email address and/or phone number so that we can contact you if we have follow up questions.
Your Phone
Your Email
Your Role:*
Please select your role-type from the options list.
Other Role*
Please enter your role-type for this report.
Time and Location
Please enter the approximate date and time the situation occurred. If the situation is on-going, or you do not know a date, you may leave this field bank.
Time

: Hours

Minutes

AM/PM
Date
MM slash DD slash YYYY
Description of the Situation
Required: Please provide as much detail as possible about your concerns. Describe what behavior, statements, observations, etc., have prompted you to make this referral and when applicable, please provide specific examples. The more information we have as a team, the better equipped we are to address the concern.
Description of your concern*
While not required, please list any steps your may have already taken (if any)
Description of steps taken
Upload Documents
Please feel free to attach any documentation related to this referral (e.g., screenshots, emails, photographs, or written work).
Drop files here or

Accepted file types: txt, jpg, jpeg, gif, png, xls, xlsx, doc, docx, Max. file size: 2 MB.
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Verification

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For transfer students

Tusculum provides a unique service for entering transfer students called an Individualized Graduation Plan (IGP). It will list all the courses that are needed in order to graduate from Tusculum, while giving you an idea of the courses you will be taking each semester.

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Our uniquely focused and practical program has enabled thousands of men and women to obtain the degrees they need to succeed professionally and personally.

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Accreditation

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STUDENT OF CONCERN FORM

STUDENT OF CONCERN

Student Information

Referral Information

Time and Location

Description of the Situation

Report Verification

CONTACT TUSCULUM ADMISSIONS