Behavior Intervention Team Referral Form
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Behavioral Intervention Team

While interacting with students across the college, faculty and staff may be confronted with situations in which a student is displaying concerning behavior. The Behavioral Intervention Team (BIT) Model is designed to assist them.

Behaviors of concern might be observed in a number of settings: in the classroom, at a service location or office, at an on-campus job, or during participation at an extracurricular activity. By reporting behaviors that are concerning, the Behavioral Intervention Team will be able to reach out to intervene, provide support, and connect them with resources that can assist them.

 
What is your Name?

This question is optional, you do not have to provide your information, you can submit this report anonymously if you would like.
 
Please provide a phone number where we can reach you below.

This question is also optional, only provide a number if you do not wish to remain anonymous.
 
Thank you for providing your information.  Please continue to provide information about the person of concern.

 
Please provide the persons name as well as their phone number if you know it.

If this is a student and you know their student ID as well as any other pertinent info please also provide that here.
 
Please select a level of referral





 
Please select a reason for referral.


 
On what date did you notice this behavior?

 
Please use this area to add any other pertinent details?

 
Where did you notice the behavior?

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