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  • CARE Team Referral Form

    Please use the form below to report any behavior(s) of concern to the CARE Team. The team will assess the information and follow up with you and/or the person of concern as appropriate. (Fields marked with an asterisk (*) are required fields and cannot be left blank.)

         Your Information
    *Full Name    
    Work Phone    
          Required format 000-000-0000
    Home Phone    
          Required format 000-000-0000
    Cell Phone    
          Required format 000-000-0000
         Information About Person of Concern
    *Full Name    
    ID Number    
          If applicable.
    *Severity Level    
    Choose as many as apply.
    *Observation Date(s)    
          If multiple observation dates, enter each date followed by a semicolon [ ; ].
    *Observation Time(s)    
          If multiple observation times, enter each time followed by a semicolon [ ; ].
    *Observation Location(s)    
          If multiple observation locations, enter each location followed by a semicolon [ ; ].
    *Detailed Description      


    Please review information for accuracy before submitting form.