Student Support Request & Referral

To request assistance from the Dean of Students Office for yourself or someone else, please complete the following form by filling in the requested information. If you have any questions after completing the report form, feel free to contact the Dean of Students Office at 413-545-2684.

In the case of urgent or life-threatening concerns, call 911 or the UMass Police Department at 413-545-2121


Please be aware that any time you record information about a student in an email, note, recording, or this referral form, the information becomes part of the student’s protected education record. Such information should be presented in a professional manner.

Please note, the Dean of Students Office’s ability to provide information back to the original reporter is shaped by University privacy policies and the federal Family Educational Rights and Privacy Act (FERPA). The “need to know” standard permits the staff to share confidential information regarding students with those who need the information in order to perform effectively in their jobs. If you are not directly involved in follow-up actions but have questions about the nature of the University’s response, please contact the Dean of Students Office.


When is it appropriate to request assistance from the Dean of Students Office?

The Dean of Students Office staff focuses on assisting students with personal or academic challenges. Examples of various challenges students may be navigating are provided below.

  • Academic:
    • If you have concerns related to course engagement, such as a student was previously engaged and abruptly stops attending classes, stops engaging with a course platform (LMS), and/or is unresponsive to academic outreach. 
    • If you are the course instructor and have concerns that are primarily about course performance, such as low grades, multiple missing assignments, or a student has never attended class, please submit a referral via Academic Alert.
    • If you are an advisor with course performance concerns about a student, you can refer them to resources such as the Learning Resource CenterSuccess Toolkit Series, and CMass Success Coaching through Navigate. If you feel a referral to one of those resources is not appropriate given the student’s needs, please contact the Academic Dean in your school/college for support.
  • Campus/Social: If you notice a student has expressed severe homesickness, reported serious roommate issues, or similar situation.
  • Medical: If you notice a student has lost a dramatic amount of weight, has left campus for surgery or treatment, reported a medical condition of concern, or similar situation.
  • Mental health: If a student has become withdrawn, has begun to exhibit behavior you find concerning, has reported acute anxiety, submits an assignment with troubling content, or similar situation.
  • Personal: If you notice a student reports a close friend or family member has died, reports a parent has recently become very ill, homeless, or reports other personal/family information.
  • Other examples would include:
    • Difficulty Transitioning to College Life
    • Not Sure Where to Access Help
    • Need to Access Multiple Campus Resources
    • Basic Needs Resources
    • Financial Struggles/Homelessness
    • Missing Classes due to a personal/family situation; Significantly Behind in Coursework
    • Injury or Illness
    • Experiencing Depression, Anxiety, Panic and/or Other General Mental Health Concerns
    • Victim of Bullying
    • Alcohol or Drug Abuse
    • Eating or Exercise Disorder

What information should I include in the description?

Reports are reviewed by the Dean of Students Office during regular business hours Monday – Friday, 8:30 AM – 5:00 PM. The staff will determine the most appropriate action, make the necessary referrals and provide support.  In order to ensure that the concern is shared with staff from appropriate offices (University Health Services (UHS), Center for Counseling and Psychological Health (CCPH), Center for Women & Community (CWC), etc.) the Dean of Students Office staff will benefit from the most complete description.

Your description should include examples of observed behaviors or details of concerning interactions, including the names of others who may have witnessed or been affected by the situation:

  • Copies of texts or emails, or any other documentation you can provide. 
  • It is also helpful to describe any steps you have already taken to address your concerns:
    • Conversations you have had with the student
    • Conversations with the student’s advisor or mentor
    • Conversations you've had with another staff member to express your concern