Please fill out this form completely, with as much detail as indicated. Referrals will be forwarded to a pass-protected email address to ensure privacy. The referrer will receive an automated response confirming that the referral was submitted and received. The referrer will receive feedback within 72 hours of submission, provided the referrer provides his/her contact information. For additional information please refer to the ACT brochure.
Additional guidance as to whether to fill out an ACT Report is provided here: Responding to Students in Distress