Student Support Referral

If you are concerned about a student’s immediate safety or it is an emergency situation, please contact Protection Services immediately at 613-562-5411.

Student information

Student number: *

Student’s first name:

Last name:

Additional Information

Please describe the reason for the referral (including the situation, behaviour or area of concern)

Any additional information, if applicable

Referral Information

Referral made by *

Title or relation to student

Phone

Email *

Please leave this field blank:

Notice of Collection of Personal Information In accordance with the Freedom of Information and Protection of Privacy Act of Ontario and with University Policy 90, the personal information is collected under the authority of the University of Ottawa Act, 1965. The personal information provided on this form, and in any subsequent submissions you make will be used by the University of Ottawa for purposes consistent with the handling of your referral and of the case management. If you have questions about the collection, use and disclosure of the personal information in this notice, please contact the Student Support team at studentsupport@uottawa.ca.