Concerned Persons Referral

Concerned Persons Referral

Concerned about someone on campus?  Complete the form below to notify the Behavioral Consultation Team.  Your report is completely confidential.

Fields marked with an * are required

Please Identify the Person You are Concerned About

Please Identify Yourself

By identifying yourself, we will be able to more fully investigate and respond to your concerns. Without your identifying information, we may not have enough information to address the situation you have described. Anonymous reports will be pursued, but the ability of the BCT to respond may be limited. Thank you for your referral.

Nature of Report

*** Please do not include the last name of the person of concern in your description ***

You may upload PDF, Word, and image files as attachments to this report. To include an email, please copy the email to Word and save as a Word document or PDF file.

Observations of Appearance or Behavior

General Observations

Issues Reported or Known to You