Pembroke Campus Support Services Team CARE Referral Form "*" indicates required fields The CARE team is a resource team, which offers a type of student and faculty support unique to the Pembroke campus. The goal of the CARE team is to bring together the expertise and responsibilities of the different campus service providers in a collaborative process to best support student success and facilitate connection to services. Prior to making a referral, please review the Supporting Students in Distress documentfor an overview of what you need to know about the team and the referral process. Student Name (First and Last):* Name of Employee or Student completing this form:* College Email of Employee or Studenting completing this form:* Program*Academic UpgradingApplied Nuclear Science & Radiation SafetyApprenticeshipBachelor of Science in NursingBusinessBusiness FundamentalsCarpentry & Renovation TechniquesComputer ProgrammingComputer Systems TechnicianEarly Childhood EducationEnvironmental Management and AssessmentEnvironmental TechnicianForestry TechnicianOffice Administration – ExecutiveOutdoor AdventureOutdoor Adventure NaturalistPersonal Support WorkerPolice FoundationsPractical NursingPre-Health Health Sciences Pathway to Advanced Diplomas and DegreesRegulatory AffairsSocial Service WorkerUrban Forestry - ArboricultureLevel or Year Please describe your concern:*Is the student aware of this referral?* Yes No Student Contact Information: Please provide student's email address or phone number HiddenSuccess Plan (Check all that apply) Academic Advising Student Success Specialist Centre for Accessible Learning Counselling Learning Strategist Peer Tutoring Academic Coaching Health Nurse Financial Aid Registrar: Drop/Add Community Resources Family Contact Additional Student Success Specialist Supports Learning Strategies Additional Centre for Accessible Learning Supports Assistive Technology Learning Strategies Please note that the CARE team is not a crisis response service. Referral forms will be reviewed as they are received and supported accordingly. The CARE team meets weekly and will discuss additional supports as needed. If the CARE team does not have a prior relationship with this student or if the student is not aware of the referral, we will reach out to the referring person and provide supplemental information that person to share with the student. For additional guidance when supporting students in distress, please review the Supporting Students in Distress Pembroke and the Supporting Students in Distress Document. Crisis, community, and other resources are also available on the Pembroke Campus counselling website, and general referral options are outlined in the Mental Health Referral Options document. Information about referrals to all Student Support and Campus Services is available here. CommentsThis field is for validation purposes and should be left unchanged. Δ