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Dallas College Student Care Referral Form

The Student Care Network is committed to supporting you in successfully navigating your personal and educational goals by offering services and resources focusing on health, wellness, and support outside the classroom. We can help you reduce barriers and assist you with the basic needs of life so you can achieve your goals. We are also available for students who may be in distress or exhibit behavior that raises concerns about the physical or mental wellbeing of themselves (or others).

If you need assistance completing this form, email connections@dallascollege.edu or call 214-860-5800 and ask for the Connections team.

To report a Code of Conduct Violation, please click here.
To report an incident of Sexual Misconduct, please click here.

This form is not for emergency situations. For life-threatening emergencies, including threat of injury to self or others, call Campus Police at 911 on a campus phone or 972-860-4290 from your device.

Your Information

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Your role at Dallas College(Required):

This field is required.

Date of first concern(Required):

This field is required.

Dallas College campus(Required):

This field is required.

Learn more

Choose the Dallas College campus which you are most affiliated.

Student Information

If you are completing this form for yourself, please submit your information below especially your Student ID number.

If you are completing this to refer a student, please list their information below. Fill in as many fields as you can provide.

First and Last Name

Select Gender

Student ID Number

Phone number

Email address

Questions

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Your Information

Student Information

Questions

Supporting Documentation

Submission