Madison Cares Referral Form
Referral Form
Please complete the form in its entirety including the Date/Time of the Concern, Nature of Concern, and as much of the Student's Information as possible, then click submit. You will receive a confirmation email from Madison Cares within 24–48 hours.
If this is an EMERGENCY, call Public Safety at 540-568-6913 or 911, then enter a Care Referral for Madison Cares to follow up. If you have questions regarding Madison Cares processes, please call the Dean of Students at 540-568-6468.
Note: All items marked with * are required.
Any information you enter concerning a student is protected by FERPA, the Family Education Rights to Privacy Act. Students have a right to view the information that you submit to us if requested.