University Behavioral Intervention Team

Behavioral Intervention Referral Form

Please use this form if you notice any concerning information, behaviors, and incidents. This information will assist in determining the appropriate solution for the individual(s).

Please tell us about the main person involved...

Is this incident or behavior ongoing?(Required)

Please tell us about yourself...

Name
Leave this blank if you wish to remain anonymous.
You can leave this blank as well but we may need to ask questions to provide the best help.

In case of an emergency or immediate threat, please call 911 or the University of Police Department at 501-916-3400. To protect the privacy of those involved, you may not receive feedback. However if you need to contact us, please stop by the Office of the Dean of Students, Donaghey Student Center, Suite 215 or call 501-916-3328.