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Partner Provider Notification Form

Please complete this form to share any serious concerns you may have about a student's wellbeing.  The form can be completed by anyone who has concerns about a student who may benefit from wellbeing support.

If your referral is URGENT or needs an immediate response, please contact Emergency Services.

Once submitted, the information will be reviewed by a Health and Wellbeing Practitioner and appropriate action taken.  We will contact you if we need more detail.

Please be aware that this referral will be viewed and actioned during the Wellbeing and Student Support standard office hours - Monday to Thursday (9am to 5pm) and Friday (9am to 4.30pm).  

 

 


REFERRER'S DETAILS


STUDENT'S DETAILS

Please identify the issue of concern (required)
Please outline any actions taken so far within the last 2 weeks (tick all that apply) (required)

When you click 'send form', the form will be submitted to Wellbeing and Student Support.

A Health and Wellbeing Practitioner will review the details and take appropriate action. 

We will contact you if we need more detail.  Thank you.

Privacy notice
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. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

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