BIT Referral

Please fill out the information below to submit a behavioral intervention referral.

If you see this don't fill out this input box.

* Reporter's Name

* Reporter's Email

* Reporter's Phone

* Time of Incident

* Date of Incident

* Location of Incident

Please provide any additional location details (For example: Building L, Library, ETC.)

* Please list the name(s) (and contact information if known) of the student(s) involved in this situation

Please list the name(s) (and contact information if known) for all witnesses to this situation

* Please provide as much information as possible about the situation, including any action taken