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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, care, and assistance to students and employees who 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, or to others).

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 concerning behavior.

 
Email address must be of a valid format.
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Indicate the affiliation of the person exhibiting the concerning behavior.
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If Urgent, 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 concern. Also include a contact for anyone else who may be willing to speak with BIT about similar concerns.

Involved party 1

Description of Behavior

Provide a detailed description of the incident/concern using specific, concise, and objective language. Include all relevant information, including who was involved in the incident, how each person was involved, what occurred, where the incident took place, and when 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?(Required)
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While the BIT will do our best to keep referrals confidential, there are times out of care, concern, and/or legal requirements it is necessary to identify the reporting party. If necessary, may we share your name with the individual?(Required)
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How would you like the BIT to follow up with you?(Required)
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Supporting Documentation

Examples that capture student's own words: Assignments, zoom/canvas comments, PDFs of email, or screenshots from social media, etc. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission