Student Care Team (SCT) Referral Form

This form serves as an electronic means of submitting timely and pertinent information to New York Chiropractic College's Student Care Team (SCT)

Please note that information regarding the referral source is treated with the utmost confidentiality. This information is very helpful if the committee has any follow-up questions or need clarification on any issue; however, an anonymous option is available to you.

Please fill in as much of this information as possible, as this will help the committee reach the student in a more timely manner.
Nature of the Incident (Select all that apply)
Please be as specific as possible when describing your concerns/the incident(s) prompting this referral.
Supporting documentation or materials may be emailed to