Oklahoma City University
Person of Concern:
Please provide as much detail as possible in answering the following questions.
Name of Individual:
This person is:
Select all that may apply.
Enter an ID if known:
Areas of Concern:
Please check all that apply.
Direct statements indicating distress, family problems, or loss
Angry or hostile outbursts, yelling or aggressive comments
More withdrawn or animated than usual
Expressions of hopelessness or worthlessness, crying or tearfulness
Expressions of severe anxiety or irritability
Excessively demanding or dependent behavior
Lack of response to outreach from staff or course instructors
Shakiness, tremors, fidgeting or pacing
Deterioration in physical appearance or personal hygiene
Visible changes in weight, statements about change in appetite or sleep
Noticeable bruises, cuts or burns
Frequent or chronic illness
Unusual inability to make eye contact
Coming to class bleary-eyed or smelling of alcohol
Concern about a student by his/her peers
A hunch or gut-level reaction that something is wrong
Your OCU Account (Optional):
This system allows for anonymous submission. However, should you like to be assured that OCU is taking steps to address your concerns then please provide your OCU account credentials at this time. This can also be of benefit if we have difficulty identifying the individual that you have listed.
I would like a personal notification that this concern is being addressed. This will require your OCU user account to be provided. As a result, I agree/understand the following:
I understand that furnishing false information is a violation of university policy.
While every effort will be made to keep the identity of the reporting person confidential, a referred person will be given specific information about the concerning behavior so that they can respond to the concern. It is possible that the referred person may determine who made the report based on the circumstances.