Student Incident Report Form

If you feel a student is a threat to themselves and/or the college community, you can refer the student to the Student Behavioral Intervention Team (SBIT) by completing this form and clicking the "Submit Form" button at the bottom of the page.

Incident Information: Student(s)
First Name:                    Last Name: ID Number if known:
First Name:                    Last Name: ID Number if known:
First Name:                    Last Name: ID Number if known:
Incident Date:             [None]
Incident Location:		Incident Time:
Did incident happen during classroom / in the library / lobby / cafeteria / other?
Any Witnesses? (students, employee, others)
Level of Concern For The Student:    (Select) Immediate Level of Concern High Level of Concern Moderate Level of Concern Low Level of Concern Unknown
Relationship to Students:                 (Select) Current Professor Former Professor Academic Advisor Club Advisor Administrator / Staff Other   If Other: (explain)