Behavioral Intervention Team Referral Form

Background Information

A member of the Behavioral Intervention Team may contact you if additional information is needed.

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Involved Parties

Please list the individual(s) involved, including as many of the listed fields as you know and are comfortable sharing. It will be helpful to include witnesses or individuals with knowledge of the incident. The College may conduct an investigation involving any named individuals and may share the details of this report with those individuals as necessary. If you have provided your name, the College will try to maintain your anonymity throughout the course of the investigation but cannot promise this outcome.

Name or Organization

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Description/Narrative of Concerning Behaviors

Supporting Documentation

If there are supporting documents that the Behavioral Intervention Team needs to be aware of, please upload them here. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Select copy recipients

Behavioral Intervention Team

Background Information

Involved Parties

Description/Narrative of Concerning Behaviors

Supporting Documentation

Select copy recipients

Submission