Behavioral Concern Report If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Complete the following form to notify the BAC Behavioral Intervention Team (B.I.T.) of a student exhibiting behavior of concern seeking evaluation or intervention by the Behavioral Intervention Team. NOTE: This form is not to be used to report an emergency. If this is a medical or psychological emergency, immediate threat of violence, substantial disruption, or a situation requiring immediate action, please contact Campus Security at 267.502 2424 or call 911. I understand that this is not an emergency * Person Submitting Report: First Name Last Name Email Phone College Affiliation * Student Faculty Staff Person Exhibiting Behavior of Concern: First Name * Last Name * Email (if known) Description of Behavior of Concern: Date of Incident * Time of Incident Location of Incident How frequently does the person exhibit the behavior you are concerned about? # of Events 1 time2-4 times5+ times Detailed description of behavior * Have you discussed your concerns with this person? * No Yes If "Yes" please explain how you addressed your concern, as well as any response you received. You can choose for your identity to remain private, or select how involve you would like to be. (Check all the apply) I wish to remain anonymous, if possibleI don't want to be involved, but I want to know my concern is addressedI want to be contacted by a member of the BIT for more consultationI would like to be involved, as appropriate, with addressing this concern Thank you for taking the time to report this concern. We appreciate your willingness to come forward.
