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Submit a CARE Report

Intervention and Referral Request

Person Providing Information
________________________________________________________________________

The Person of Concern Information
_______________________________________________________________________

If the person is in a class with you or you know of a class that they are taking, please include the following:
_______________________________________________________________________

Immediate Needs
________________________________________________________________________
Check all needs that apply
Type of concerning behavior
________________________________________________________________________
Check all behaviors that apply

Please indicate selections from the relevant category/categories. Circumstances associated with the person of concern that have been reported or known to you personally
________________________________________________________________________

Check all circumstances known

Indicators & Behaviors of Suspected Terrorists
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Check all indicators that apply
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