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Behavioral Report Form

Please complete this form with as much specific detail as possible. The contents will be sent by email to the BIT for review. If you would rather complete the form in MS Word format, and deliver it to the BIT staff, please click here.

We will respond within 72 hours to your report or email. BIT is not an “immediate need” service. Remember, this is not an emergency service. If you have an emergency situation, contact Campus Police at 909-652-6911.


   

Date Report Submitted
*
  Please select the appropriate button:
Information only report (no contact needed)
Have BIT member contact me within 72 hours
   
  Contact Information

First Name
*
  Last Name
*
  Department
*
  Phone/Extension
*
  E-Mail Address
*
  Employment Group *
Faculty      Staff    
   
  Concern Details

  Name of Student of Interest
*
  What is the student's Chaffey ID number (if known)?
   
  How do you know this person (or come into contact with him/her)?
*
   
 
*
   
  In what way(s) does this behavior concern you?
*
  * Entry required in this field
   
 
   




 


Rev. 9/4/13


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