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Behavioral Threat Assessment and Management Team


IF THIS IS AN EMERGENCY DO NOT USE THIS FORM. INSTEAD, CALL 911.

Send a person of concern report by completing the items below.

Please note that certain professionals on the BTAM may be required to report or take other immediate action required by law based on the information submitted on the referral form.

Background Information

Please provide the following information:

 
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e.g., student, faculty, staff, visitor
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Person of Concern and any additional persons involved

Please list persons involved (excluding yourself), Provide information in as many of the data fields as you can. Please start with identifying the person of concern and then add any others that may be involved or have relevant information.

Involved party 1

Questions

In this referral to the Behavioral Threat Assessment and Management Team, please select categories and provide related narratives that document what you factually know. It is important to avoid personal opinions, judgments, or inferences about the person or circumstances.

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Please indicate selections from the relevant category/categories which pertain to the person of concern in this report. Observations of Personal Appearance - Check all that apply(Required)
You must make at least one selection.
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Please indicate selections from the relevant category/categories that pertain to the person of concern in this report. Physical Signs of Distress - Check all that apply(Required)
You must make at least one selection.
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Please indicate selections from the relevant category/categories that pertain to the person of concern in this report. Emotional Observations - Check all that apply(Required)
You must make at least one selection.
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Please indicate selections from the relevant category/categories that pertain to the person of concern in this report. General Observations- Check all that apply(Required)
You must make at least one selection.
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Please indicate selections from the relevant category/categories. Circumstances associated with the person of concern that have been reported or known to you personally. -Check all that apply.(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