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CARE Referral Form


Thank you for submitting a referral to the CARE Team. Please complete as many fields as possible so that we can provide the most thorough response. If this is an emergency, please call Campus Safety at 703-284-1600 or 911. 

Follow these links to learn more about the CARE Team and the CARE Referral Process.

Reporter's Information

 
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Email address must be of a valid format.
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Submit to receive confirmation of receipt and an automated message detailing our CARE process
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If you believe this referral is high (critical) contact 911 and/or Campus Safety at 702-284-1600.
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Student of Concern

Please indicate the student you are concerned about below. 

Involved party 1

Reason for Report

If you have any questions or concerns when completing this report, please contact the CARE Team at: care@marymount.edu or (703) 284-6489.

Please check the appropriate boxes that relate to your concerns. This form can be used for self-referral or for the purpose of reporting a concern about the behavior of others. In the narrative section, provide detailed information regarding the concern you are reporting. Once the form is received, the appropriate party will review the report and take action as necessary which may or may not include contacting the individuals involved or you. If you are submitting a report that including (but not limited to) sexual assault, non-consensual sexual contact, interpersonal violence (relationship violence), victim of a crime or harassment, stalking, sexual harassment, cyber-bullying, sexual exploitation, complicity, and/or retaliation, please also fill out a Title IX Report.(Required)
You must make at least one selection.
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If necessary, may we share your name with the student?(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission