Student Behavior Report Form
If you feel you or someone else is in immediate danger of an act of violence or if this is an emergency situation, do not complete this form. You may call 911 immediately or access the one-way announcement system (Dial 8801) from any BCC phone on campus to announce the situation. This report is an official communication with the College and is confidential. Be as clear as possible and only report observed facts and personal impressions when describing the behavior. Do not report things you did not see/hear or make assumptions based on other's impressions.
Acknowledgement *
By selecting "yes". I acknowledge that BIT is not an emergency response team
Today's date *
MM
/
DD
/
YYYY
Pick the appropriate action *
Report Type *
Please select the type of situation that you are reporting
What is the student's BCC ID number (if known)?
Leave field blank if BCC ID# is unknown
Your answer
Name of Student of Interest
Enter the student's full name
Your answer
ONLY describe the person being reported if the name is unknown
Provide basic details: (example: gender, race/ethnicity, height, weight, clothes, hair length, etc.)
Your answer
Descriptive Information *
Please provide as much information as possible about the observed behavior
Your answer
In what way(s) does this behavior concern you? *
Your answer
Date of initial observation *
MM
/
DD
/
YYYY
Time of initial observation *
Time
:
Location of the occurrence *
Additional Location Information
If applicable, please provide any additional location details
Your answer
Course and Section (if applicable)
Please provide the course number and section number (e.g. CIS 110 01WA)
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service