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Behavioral Intervention Form


This form is for non-emergency and non-safety related concerns and will only be received during normal business hours (Monday - Friday, 8:00 a.m. - 5:00 CST) and may take up to 72 hours to review. Once this form is received, the information will be reviewed to take appropriate action, which may not include contacting the student, you, or any others you have identified.

If there is an immediate threat or you require emergency assistance, please contact University Police at 936-294-1800 or dial 911.

If your report is regarding discrimination or sexual misconduct, please report to SHSU Title IX . 

If the student meets one or more of these criteria, please complete this form: 

  • Individual engages in suicidal talk or self-harm.
  • Individual makes vague threats to harm others that might be for a direct or indirect target.
  • Behavior is increasingly disruptive and involves multiple offices such as student conduct, law enforcement, and counseling.
  • Moderate risk of substance dependence. 
  • Student self admits for mental health care. 

If the student is in immediate harm to themselves or others, please call the University Police Department at 936-294-1800.  

Background Information

 
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student, faculty, parent
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Involved Parties

Please list the individuals involved, excluding yourself.   

Failure to provide this information could result in this report being discarded. 

Involved party 1

Information Regarding Behavior

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I am concerned about the following behaviors (check all that apply):(Required)
You must make at least one selection.
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Was anyone transported to the hospital, jail, or other location?(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.

Submission