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Concerning Behavior Referral Form


To report an emergency, DO NOT use this form. Call University Police Department at (408) 924-2222, or dial 911.

 

San José State University maintains the Behavioral Intervention Team (BIT) that provides guidance, 护理, and assistance to students and employees 谁 are experiencing crisis, displaying odd or unusual behaviors, or engaging in other behaviors that may be perceived as being harmful (either to the student or employee individually, 对别人也一样).

Reporting Party Background Information

While anonymous referrals are accepted, you are STRONGLY encouraged to provide your name and contact information in order to allow BIT to most effectively address the 关注ing behavior.

 
Email address must be of a valid format.
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Indicate the affiliation of the person exhibiting the 关注ing behavior.
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If 紧急的, consider calling University Police Department at (408) 924-2222, or dial 911.
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Involved Parties

Provide identifying information about the student or employee of 关注. Also include a contact for anyone else 谁 may be willing to speak with BIT about similar 关注s.

Involved party 1

Description of Behavior

Provide a detailed description of the incident/关注 using specific, 简洁的, and objective language. Include all relevant information, including 谁 was involved in the incident, 如何 each person was involved, 什么 发生时, 在哪里 the incident took place, and 当 the incident took place.

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Is the individual aware that you notified the Behavioral Intervention Team (BIT) or informed other need to know staff at 菠菜网lol正规平台?(必需)
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While the BIT will do our best to keep referrals confidential, there are times out of 护理, 关注, and/or legal requirements it is necessary to identify the reporting party. If necessary, may we share your name with the individual?(必需)
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How would you like the BIT to follow up with you?(必需)
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Supporting Documentation

Examples that capture student's own words: Assignments, zoom/canvas comments, 电子邮件的pdf格式, or screenshots from social media, 等. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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