Faculty and Staff Early Assist form

The Early Assist form is designed to connect students with the appropriate supports to enhance their wellbeing. Topics that may be referred include behavioral concerns, concerns for health and wellbeing, non-academic misconduct, academic concerns, etc. Completing this referral is voluntary and will not reflect on a student's academic records.

Please read before prceeding:

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 Early Assist - Faculty and Staff 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

Referring Party Name *

Referring Party UNBC Email *

Referring Party UNBC EXT Number - Optional

Referring Party Relationship to Student *

E.g., Faculty or Staff

Student of Concern

Student of Concern’s First Name *

Student of Concern’s Last Name *

Student of Concern’s Pronouns - Optional

Student of Concern’s UNBC email - Optional

NOTE: Without this information, response could be delayed.

Student of Concern’s UNBC Student Number - Optional

NOTE: Without this information, response could be delayed.

Additional Information

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.

What support or outcome are you hoping for? - Optional

? Please note we will take your request into consideration, but it is not guaranteed.

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

I read and agree to the privacy policy below *

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.