Behavioral Intervention Reporting Form

Behavioral Intervention Reporting Form

Although instances of UNH students engaging in disruptive, threatening or violent behavior are rare, there are some behaviors that will raise concern among faculty, staff and students. Concerning behaviors that can be considered out of the ordinary can take place in and out of the classroom, as well as on and off campus. It is important to remember that early intervention of such behaviors is crucial.

By completing this form, you are notifying the Behavioral Intervention Team (BIT) of your concern in an effort to keep our students and university community safe. Signs of concerning behavior include, but are not limited to:

• Disorderly or significantly disruptive behavior
• Verbal or written aggression (uncontrollable anger, hostility, frustration)
• Unusual behavior or sudden/drastic change in demeanor
• Communicating or implying intent to harm self or others
• Destructive behavior or property damage
• Stalking behavior
• Acts of violence (pushing, assaulting, hitting another person)
• Possessing a weapon (firearm, facsimile weapon, guns, knives, switchblades, swords, etc.)

If your concern is immediate, please contact Campus Police at 203-932-7070 or call 911. Otherwise, please complete the form below. Your confidentiality and trust are very important to us. Every effort will be made to respect your privacy, however please be aware that in circumstances involving the compromising of community safety or criminal action, it may not be possible to guarantee anonymity.

Reporter Information
Name Name First Last
Position at UNH

Position at UNH Faculty Staff Student Parent/Guardian Other Other
Phone Phone - ### - ### ####
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Relation to Student of Concern
Student of Concern's Information

Please complete as much information as possible.
Student's Name Student's Name First Last
Student's Email
Student's Phone Student's Phone - ### - ### ####
Student ID Number
Undergraduate or Graduate

Undergraduate or Graduate Undergraduate Graduate
Domestic or International

Domestic or International Domestic International
Residential or Commuter

Residential or Commuter Residential Commuter
Student's Address Student's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Class Year
Major/Minor
Campus Involvement (athletics, student organizations, etc.)
Social Media IDs/Links (Facebook, Twitter, etc.)
Concerning Behaviors and Issues

Below are examples of concerning behaviors and/or issues. Please check all that apply.

Concerning Behaviors and Issues

Below are examples of concerning behaviors and/or issues. Please check all that apply. Academic Related Issues Alcohol/Drug Abuse or Misuse Bullying Concerning Interests or Obsessions Disrupting Classroom Eating Disorders Family Related Issues Hate or Bias Related Actions Hazing Physical Aggression Physical or Cyber Stalking Possession of a Weapon Property Damage Relationship Abuse Self-Injurious Sexual Assault Sexual Harassment Student Writings or Social Media Postings Threat of Physical Attack Verbal Aggression Other Other
Description of Concerning Behavior or Issues

Please provide a detailed (dates, times, locations, actions, participants, witnesses, etc.) description of the behavior(s) that you observed. Any additional information about the student is also helpful.
Additional Questions
Have you reported this incident to the UNH Police Department or other authorities?

Have you reported this incident to the UNH Police Department or other authorities? Yes No
Would you like to remain anonymous?

Please note that in cases involving the compromise of community safety or criminal action, it may not be possible to guarantee anonymity.

Would you like to remain anonymous?

Please note that in cases involving the compromise of community safety or criminal action, it may not be possible to guarantee anonymity. Yes No
If you have supporting documentation (photos, video, emails, etc.), please email them to reportit@newhaven.edu or hand deliver hard copies, marked “Confidential,” to the Dean of Students Office, Bartels Hall, Room 203. Please, do not use inter-office mail.