Care and Concern Form
This form is intended for reporting student behavior that would benefit from support services - not for reporting a concern that requires immediate action.
For concerns requiring immediate action, please contact public safety at (978) 556-3689 (Haverhill) or (978) 738-7499 (Lawrence). In an emergency you should dial 911.
Name of Person Reporting
About the Concern
Name of Student
Name(s) of Others Involved
Date of Behavior
Time of Behavior
Please provide a description of the behavior
(please use concrete, observable and specific details and refrain from describing judgements or opinions)
Daniel J. Malavé
Director of Student Conduct
Coordinator of Civic Engagement, Service-Learning and Community Resources
Do Not Fill This Out