Bethany Cares - Student of Concern Report

Bethany Cares - Student of Concern Report

If this is an EMERGENCY, immediately call 911 and/or contact Campus Security at 507-344-7888.

If you are concerned about a student who is displaying behaviors that may interfere with their ability to be successful or function well, you are encouraged to report the concern to an appropriate college representative.

Examples of behaviors for Bethany Cares reports may include: excessive class absenteeism, uncharacteristic poor academic performance, disruptive behaviors, self-injurious behavior, mental health concerns, or any other concern about a student’s welfare.

This reporting form will direct your concerns to the appropriate resources of Bethany Lutheran College. Thank you for reporting. Student safety is of the utmost importance to us.

Submissions to this form will be read within one business day by Ted Manthe, Ryan Bolte, and/or Kristi Ringen. They will direct your report as appropriate to other members of the Bethany Cares team, depending on the type of concern and the content of your report.

* Fields marked with a red asterisk are required.

Student of Concern
Student's Full Name
Student ID number (if known)
Must be a number less than or equal to 9999999.
Student's Classification

Student's Classification Freshman Sophomore Junior Senior PSEO Unknown Other: Other:
Student's Phone Number Student's Phone Number - ### - ### ####
Concern Details
Type of Concern

Type of Concern Academic Conduct Mental Health Physical Health Other: Other:
Urgency

Urgency Urgent. The life of the reported student is of concern. For Emergency, call 911 immediately. Not urgent.
Location (if relevant)
Additional Location Details
Details of Your Concern

Describe student behaviors that are currently a cause for concern. Plain text only.
Concern
How long has the above behavior been happening?
When was your last communication with the student?
Reporter Details

Optional but recommended. Providing your information will help us resolve your concern.

If you provide an email address, we'll email you a copy of your submission.
Your Name
Your Email
Your Phone Number
Your Relationship to Reported Student

Your Relationship to Reported Student SELF (student) Roommate Friend Parent Instructor / Professional Staff Other: Other:
Submit anonymously (not recommended)
Anonymity Note - Please Read Carefully

Anonymous reporting is optional, and may reduce the effectiveness of Bethany's response, since we will not be able to contact you if we have additional questions or need clarification.

If you do not provide your name and contact information in the Reporter Details section and check the "Submit anonymously" checkbox above, this form will be considered anonymously submitted. Bethany will not make any attempt to discover your identity unless required to do so by law.

PLEASE NOTE: Use of this form does not guarantee anonymity since your IP address and other information about your device may be transmitted to our servers. For additional anonymity, you may wish to submit this form using a public computer such as one available at a public library, or using a privacy-focused VPN service.