University of Kentucky Logo

TRACS (Triage, Referral, Assistance, and Crisis Support) Hub Intake Form

BEFORE YOU BEGIN: If there is an immediate threat to self or others, immediately contact the University of Kentucky Police Department at #UKPD (#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.

Submit this form to request support or assistance for a student who are expericing personal, physical, emotional wellbeing, or circumstances you believe would benefit from increased support please fill out the form with as much information as possible.

If you are the student experiencing distress at this time, please complete the form and we will reach out to you directly. If you have questions or concerns about referring yourself or others and wish to speak to a to a team member you can call (859)21TRACS (859-218-7227).

Background Information

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Date of Occurance(Required):

This field is required.

Learn more

If ongoing, select today.

Time of Occurrence:

Location of incident(Required):

This field is required.

Name of Person or Organization Involved

Name or Organization

Select Role

UK ID Number

Phone number

Email address

Questions

Supporting Documentation

Provide any documentation related to the reason you are filling out this form. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Name of Person or Organization Involved

Questions

Supporting Documentation

Submission