Behaviors of Concern Report (BIT)

Contact Information

Please provide your contact information below. Please note that reports submitted anonymously may severely limit our ability to fully assess and follow-up.

First and Last Name:

(i.e. Faculty, Staff, Student):

Phone Number (XXX-XXX-XXXX):

Email Address:

Email address must be of a valid format.

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Montgomery College email address

Office # (Example: MT 605):

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Building and room number

Date of Incident(Required):

This field is required.

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On what date did the incident take place?

Time of Incident:

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On which campus did the incident take place? If online, choose your home campus.

Incident Location(Required):

This field is required.

Building & Room # of Incident:

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Where did the incident take place? (e.g. PK 108)

Student's Information

Please provide the name and the M# for student of concern.

First and Last Name

Student's M# (use a capital M)

Incident Report Details

Please use the following areas to describe the incident/behavior of concern.

Provide a detailed description of the incident/concern using specific, concise, objective language.(Required) This field is required.

Have you tried to speak to the student about the incident?(Required)

Yes No

This field is required.

By submitting this report you agree that the information is accurate and you understand that the report cannot be rescinded.(Required)

Yes

This field is required.

Supporting Documentation

Please attach any documents that are pertinent to the case (i.e. concerning email, assignments, letters, etc).

5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Contact Information

Student's Information

Incident Report Details

Supporting Documentation

Submission