This form is for any employee or student who is having concerns about a student. The types of concerns may be behavioral in nature such as class, office or activity disruption or inappropriate comments. This can also demonstrate in class assignment on line or on paper. Sometimes you may have a concern regarding a dramatic change in the student's demeanor, attendance or grades. The form is also used when the student is perceived to be under the influence of drugs or alcohol. Cyber bullying or stalking should also generate a report.
This form when received allows the team to take immediate action to help the student or resolve the situation.
Note: Fields marked with an * (asterisk) are required.
Please complete this electronic form as fully as possible. The information you share may be made available to the student and should reflect only what you have observed or your specific knowledge of the incident.
Note: This form will be submitted to the Dean of Student Affairs and Mary Jones, Ventura College Student Health Center Coordinator.