Care Form

ATTENTION: Call 9-1-1 if you are in imminent danger or need medical attention. Then call CCA Public Safety at 415.703.9510.

Be sure to Submit the form -- even if it does not map to the categories listed or is submitted as a notification only.

About the CCA Care Form

By completing this form, you are providing information CCA information about yourself or a student in need of support, or a concern you may have, which may include, but is not limited to, the following areas:
  • General wellness and student success support needs or concerns
  • Threat of possible violence (to self or others/campus)
  • Violation of campus policy
  • Sexual or gender-based misconduct
  • Unlawful harassment or discrimination
Submissions are reviewed during regular business hours and routed to the appropriate staff member or office/group including, but not limited to; the CCA Care team, Academic Advising, Academic Affairs, a student conduct officer, or a Title IX intake officer. 
Depending on the nature of this notification, the information may also serve as the basis for a behavior assessment, Title IX investigation, or the initiation of the student conduct process, or both.
Once you submit the form, you'll receive a confirmation. 
For more information, contact