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Get Help Form


Please submit this form for any student experiencing circumstances impacting their personal, physical or emotional well-being, exhibiting behaviors that are a cause for concern, or for a student you believe could benefit from increased support. Please fill out the form with as much information as possible to assist in outreach efforts. 

This form is received and collaboratively processed by multiple Student Success units: The Center for Support and Intervention and TRACS Hub (including Basic Needs supports). 

If you are the student experiencing distress or difficulties at this time, please complete the form as a self-referral and we will reach out to you directly.

If there is an immediate threat to self or others, immediately contact the University of Kentucky Police Department at (859) 257-8573 (#8573 on your cell). Reports submitted via this form are reviewed during UK's normal business hours and are not monitored after hours, on weekends, or during official University holidays. 

This form is an official communication with the University of Kentucky.

About Yourself

Note: If a report is submitted anonymously, staff may be limited in the outreach and support they can provide.

 
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i.e. faculty, TA, staff, student, parent, community member, etc.
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Please share the best number to contact you during Monday through Friday between 8 AM and 5 PM.
Email address must be of a valid format.
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You will receive a confirmation email at this address.
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e.g. College of Arts and Sciences, College of Engineering, Dean of Students, First Gen
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Select option the best describes primary concern. Additional details can be added in next section.
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If unknown or ongoing issue, use today's date
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If applicable
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List the location the incident occurred, address, building name, any descriptors are helpful.

Referred Student Information

Please list the name(s) of the person(s) you are concerned about. Please include at least one additional identifier, such as email, phone number, UK ID, etc., to ensure we can identify the correct individual for outreach. 

If you have concerns for yourself and would like to make a self-referral to our office, please submit your own information below.

Involved party 1

Tell us about your concerns

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Please check any concerns below that are relevant to this referral. We also ask that you use the text box below to describe your concerns in detail.(Required)
You must make at least one selection.
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What campus resources have you referred the student to?(Required)
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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 an immediate threat to safety and/or life. I acknowledge that in such instances, 911 or University Police should be called by dialing (859) 257-8573.(Required)
You must make at least one selection.

Supporting Documentation

Please include any emails, screenshots, photographs, or other documentation you have that may be helpful to us in looking into this concern. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission