Refer a Student for Assistance | Dean of Students Office

Do you know of an Iowa State student who is experiencing difficulties? To inform the Dean of Students Office about a student you feel would benefit from outreach, you may fill out our online referral form, or call 515-294-1020 to speak to our staff directly about your concerns. We will assess the information you provide and contact the student directly. If the student is disruptive and uncooperative, appears volatile or dangerous, or is demonstrating immediate harm to self or others: call 911 or the Iowa State University Police at 515-294-4428 for immediate assistance.

Please provide as much information as you can. If there are questions you cannot answer, you may skip those questions. We welcome any information you have about students. We abide by professional confidentiality and we comply with FERPA regulations.

Name of Student *

Identifying Information *

Please provide any additional identifying information to help us contact the student. (Examples include: University ID#, Major, birthdate, address or cell phone number.)

Concerns *

Describe your concerns. Please include specific behavioral descriptions and provide as much detail as possible.

How did you learn about the incident(s)? *

Is the student aware of your report?

Yes

Are there others who are aware of the incident(s)?

Yes

Don't Know

Name and Contact Info of Other Individual(s)

If so, please provide the names and any contact information for any other individuals with knowledge about this situation.

Thank you for referring your concerns.

To complete the on-line referral process, please verify your authenticity by answering the Captcha question below and click "Submit".

To ensure the Student Assistance staff can follow-up effectively, we invite you to provide your contact information. This is optional, and won't impact our efforts to assist the student you are referring.

Your Name

Your Email

Your Phone Number

CAPTCHA

This question is to prevent automated spam submissions.