Behavior Intervention Team

BIT Home

FAQs

Guidelines

Who to Contact

Members

Report Form

Resources

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.


	Date Report Submitted *

	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)? *

	Please provide a description of the behavioral concern. Include detailed informayion of your observation such as frequency of behavior observed, day, time and location where behavior occurred, witness willing to corroborate, etc. Please feel free to send additional documents via email (chaffeybit@gmail.com) if needed for explanation. *

	In what way(s) does this behavior concern you? *
	* Entry required in this field

Rev. 11/5/12

Content on this page requires a newer version of Adobe Flash Player.