Boettcher Scholar Risk Reporting Form
If this is an emergency, please immediately dial 9-1-1.
Suicide & Crisis Lifeline: 988
Colorado Crisis Services
Call: 844.493.8255
Text: "TALK" to 38255
BetterHelp:
Accessible via the email sent to you personally
For help accessing the portal, contact Jackie Yelton (
jackie@boettcherfoundation.org
)
Risk Assessment
If you believe a current Boettcher Scholar may be in need of additional support or resources, please inform the Foundation by completing all required fields below.
Do you believe this person is currently experiencing a crisis situation (life-threatening or threatening to others)?
Yes
No
THIS IS AN EMERGENCY SITUATION.
PLEASE IMMEDIATELY DIAL 9-1-1.
Reporting Form
Boettcher Scholar's First Name
Boettcher Scholar's Last Name
Boettcher Scholar's College or University
Reporting Party's First Name
Reporting Party's Last Name
Reporting Party's Role
Alumni Mentor
Campus Mentor
Friend
Parent
Scholar
Other
Other
Please indicate below the type(s) of risk that you are reporting regarding the above-listed Boettcher Scholar:
Academic
Financial
Health
Situational
Other/unknown
Please provide a detailed explanation of your concerns.
To best support Boettcher Scholars, it is extremely helpful for Foundation representatives to have the opportunity to discuss these matters further with the reporting party or parties.
Do you give your permission for a Foundation representative to contact you for additional details?
Yes
No
Preferred Phone Number
Preferred Email Address
Contact Information