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Concerning Student Behavior Form


Miles Community College's Behavioral Intervention Team exists to help maintain a healthy and safe campus environment. This form is intended to encourage faculty, staff, and students to voluntarily report "red flag" student behaviors (personal, academic, social, etc.) or health related (student illness, death, etc.)that have the potential of impacting a student's success. The goal is to work with students to address concerns before they reach a level involving student conduct violations or academic/financial aid issues.

BEFORE YOU BEGIN: If this is an emergency that requires immediate attention, please contact the Miles City Police Department at 911 or 406.232.3411 prior to completing this referral form. This form is not designated as an emergency response notification.

For assistance or consultation while completing this referral, please contact the Dean of Student Engagement at 406.874.6226. To report matters related to student conduct, please use the "Report Harassment or Sexual Assault" or "Report a Student Conduct Code Violation" forms found on MCC's campus safety website: https://www.milescc.edu/AboutUs/CampusSafety/.

Additionally, academic at risk reports may filed on the academic risk form on the faculty/staff secured forms page.

What happens after the referral is made?
Students referred will be contacted and offered assistance and/or resources from the Dean of Student Engagement or an appropriate designee depending on the nature of the concern described below. If the behavior is disruptive, the form may be used for disciplinary purposes.

Your Information

 
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If an emergency, call 911 or 406.232.3411 for Miles City Police Department.
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Involved Parties

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Information Regarding Concern:

Please check any behaviors/conditions below that have led you to be concerned about the individual involved. If no boxes apply, please use the text box below to describe your concerns in detail.
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Are you or the person you are writing about experiencing symptoms, concerned about COVID-19, and/or needing assistance? (If yes, please self-quarantine and contact physician--oneHealth 406-874-8700; Holy Rosary Healthcare 406-233-2600; Billings Clinic 406-233-7000.)(Required)
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Are there other issues related to the student of concern such as any listed below?
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Do you wish to remain anonymous if/when this student is contacted?(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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