ConnectU referral form

ConnectU encourages student success by reducing barriers to access support. This form may also be used as a self-referral. Topics that may be referred include bullying and harassment, concerns for a student, students experiencing distress, etc. Completing this referral is voluntary and will not reflect on a student's academic records.

Please read before proceeding:

If this is an emergency, do not submit a ConnectU referral. This is not a 24/7 emergency referral. Use this form only as a follow-up to an emergency.

If you require immediate attention for the safety of yourself or others, please contact the appropriate authorities below. If possible, contact UNBC Security Services for the Prince George campus at 250-960-7058 to keep a record of the incident.

Harm to self or others (concern for public safety): 9-1-1

Concerns for minors (anyone under the age of 19): Ministry of Child and Family Services - 250-645-4105

Visit the ConnectU Support Service web page for more information.

Important information

You will not receive a copy of your referral. If needed, take a screenshot or copy and paste your responses into a Word document. You will not receive a copy of your submission once you submit the form.

Avoid timing out. There is a chance that this page may time out. To avoid timing out, you may want to write your description in a Word document and then paste that into the form when you are ready.

Ensure your submission goes through. Once you submit the form, you will be taken to a confirmation screen. If you are concerned about your submission going through successfully after clicking “Submit”, contact us directly at connectu@unbc.ca.

Referring party information

Referrer: *

I am referring myself

I am referring someone else

First name: *

Last name: *

Email address: *

Phone number: *

Student information

First name: - Optional

Last name: - Optional

Student's preferred pronouns: - Optional

Pronouns: - Optional

Student's UNBC ID number: - Optional

Relationship to student: - Optional

e.g. faculty, staff, parent, or friend.

Description of situation: *

To the best of your ability, please provide as many relevant details as possible about the situation, including any context, history, other parties involved, etc.

Actions taken: *

What, if anything, has already been tried to address the situation? This information will assist us in providing a more helpful, tailored response.

Desired support or outcome: - Optional

What support or outcome are you hoping for? Please note we will take your request into consideration, but it is not guaranteed.

Privacy statement

The personal information collected through this form is under the authority of the Freedom of Information and Protection of Privacy Act. Any information that you provide is treated confidentially and will be accessed by UNBC’s Restorative Relations and Student Supports (RR & SS) department. The RR & SS department may share relevant information internally for the purpose of identifying UNBC students, to consult in follow-up, and connect students with appropriate supports. The RR & SS department may also share some information provided with the student identified when offering support.

By submitting this form, the information will be sent to connectu@unbc.ca and will be kept confidential within the scope of which the situation necessitates or as required by law.

If you have any questions or concerns, contact the Restorative Relations and Student Supports Coordinator at connectu@unbc.ca or call 250-960-6435.