Student Concern Form

I am a requesting assistance or information for:

Myself (students only)

A student other than myself (students, faculty, staff, or other community members)

The Student Solution Center is committed to helping you resolve any issues or concerns that may arise throughout the semester. If you aren't sure where to go for help or if you have a complex issue that may involve multiple offices on campus, you've come to the right place! Please fill out the following information and we'll be in contact with you shortly!

UIndy is committed to helping students resolve any issues or concerns that may arise! We work with students who have a range of academic and personal barriers that prevent them from being successful.

The goal of this reporting tool is to provide a way for all members of the UIndy community to report concerns, ask questions, or seek support with complex issues that may involve multiple offices on campus.

Additional Notes:
If you or a student need immediate assistance or a welfare check, please contact Campus Police by dialing 9-1-1.

Student Concern submissions are not anonymous; the name of the community member sharing the concern could be shared with the student during the outreach process.

If you are reporting a Title IX concern, please complete the Title IX Form

Student Information

Your Information

First Name

Last Name

Your UIndy Student ID (A#)

UIndy Student ID (A#) -- if known

Your UIndy Email Address

Student's UIndy Email Address -- if known

Best way to contact you:

Email

Phone

Google Meet

In-person meeting

Issues you would like to discuss

Select the academic concern(s) you are experiencing:

Other academic concern:

Select the personal concern(s) you are experiencing:

Other personal concern:

Comments or Concerns:

Student Concern Details

Select the academic concern you are reporting:

Other academic concern:

Select the personal concern you are reporting:

Medical or health concern

Mental health concern

Drug and alcohol-related concern

Knowledge of a personal or family difficulty (i.e., death in the family)

In need of basic essentials (i.e., housing or food)

Other

Other personal concern:

Comments:

Your Information

Your first name

Your last name

Your email

Your role at UIndy:

Student

Faculty

Staff

Other Community Member