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转介护理小组


If you need to report an emergency, do not use this form. Instead, call the Old Dominion University Police at (757) 683-4000, or dial 911.

You may use this form to submit any concerns regarding the wellbeing of an ODU student. Please be sure to complete as much of this report as possible and provide your contact information in case a staff member needs to follow-up with you for more information.

This form is not intended to be used to refer a student through the student conduct process. To refer a student for a potential Code of 学生 Conduct violation, please click 在这里.

If you are a student seeking information about how to request an Extended Class Absence or an Administrative Withdrawal, 请访问 学生接触 & 支持 for more information and request forms.

Background Information

 
电子邮件地址 must be of a valid format.
这个字段是必需的。.
这个字段是必需的。.

涉及党

Please list yourself and the individuals involved, including as many of the listed fields as you can provide. For non-students involved in the incident, please list any available information.

教师 should enter their ODU email address (minus the "@chinaqinyu.com") in the "印尼学生" field when adding themselves as an Involved Party.

参与方1

转介详情

Please provide a detailed description of the incident and/or your concerns using 具体的, concise, objective language. Please refrain from using pronouns to refer to people in the body of the report. In your description, focus on the who, what, w在这里, when, and how. Indicate 具体的 words, phrases, and interactions. 例如, if a student spoke of harming him/herself, indicate the actual words/phrases that were used.

If you have any supplemental information to share (such as photos or emails), please upload to the "支持ing Documentation" section of this referral or email supporting information to oducares@chinaqinyu.com following submission of this report.

这个字段是必需的。.
Issues/concerns that may related to this referral (selected by the person submitting the referral):
You must make at least one selection.
这个字段是必需的。.

支持ing Documentation

Photos, video, email, and other supporting documents may be attached below. 最大总大小为5GB.
Attachments require time to upload, so please be patient after submitting this form.

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