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    Behavioral Assessment Team Report


    Behavioral Assessment Team Referral Form

    Instructions: Please complete this form with detailed information about the behaviors observed or reported. All provided details will be treated confidentially unless otherwise communicated to you.

    Examples of behaviors to report: Self-injury, suicidal thoughts, disruptive behavior affecting college operations or safety, or any other behavior you feel someone at the college needs to know about or address.

    Please be sure to attach any additional information you feel might be helpful for us to know or review. 

    Do you have immediate safety concerns? CALL 911!

    The BAT will review and assess the referral, communicating outcomes to the referrer. Thank you for promoting campus safety. 

    Please complete the following information as the individual completing this report. If you would like to remain anonymous, please place a "N/A" in the appropriate fields.
    Date
    Date
    Please provide the following information for the individual(s) you are reporting:
    Birthdate
    Birthdate
    Date of Incident or Occurrence
    Date of Incident or Occurrence

    By submitting this form, I understand that the College may be obligated to take measures to address potential violations of Title IX, CCCC Code of Conduct, or other regulations as necessary. I understand that the College prohibits Retaliation against a reporting party. I also understand that if a reporting party makes a false accusation, the reporting party will be subject to appropriate disciplinary action.
    By submitting this form, I understand that the College may be obligated to take measures to address potential violations of Title IX, CCCC Code of Conduct, or other regulations as necessary. I understand that the College prohibits Retaliation against a reporting party. I also understand that if a reporting party makes a false accusation, the reporting party will be subject to appropriate disciplinary action.