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Missing student referral form

This form is to be completed in conjunction with the document Wellbeing Support Services guidance for academic departments around non-engagement and missing students

Please note that all fields are mandatory.  If you do not fill in the form correctly, we may need to return it back to you for additional information.

Dates of contacts by department:

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This form is anonymous. No data which personally identifies you is collected on the form, and the data you provide is used solely to help us improve the delivery of our courses.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University’s Data Protection webpages provide further information on your rights and how the University processes personal data. Please submit any data subject rights requests to or address any complaints or suspected breaches to the University’s Data Protection Officer at

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