Please complete the following form to share your concern for a UTC Faculty or Staff member. A CARE Team member will review the content and determine necessary next steps.

Referrals may be made anonymously if desired by leaving contact information blank.


Clicking "Done" at the bottom of this page, once all necessary information has been provided, will submit your referral.

Question Title

* 1. Referral Date:
(Please enter today's date in the space provided below)

Question Title

* 2. Contact name (optional):
(Please provide your name in the space below if you agree to be contacted about the content of this referral)

Question Title

* 3. Contact phone number (optional):
(Please provide your phone number in the space below if you agree to be contacted about the content of this referral)

Question Title

* 4. Person of concern:
(Please provide the following information about the person of concern for which you are submitting this referral. Please understand that no one will contact this person to share with them that a referral has been submitting about them)

Question Title

* 5. Relationship to person of concern:
(Please indicate what your relationship is to the person of concern by selecting an option below)

Question Title

* 6. Please describe observed behavior of concern, providing as much details as possible so we may best understand the situation at hand.

T