Report/Share a Concern

Behavioral Concern Report

Complete the following form to report an individual exhibiting behavior of concern seeking evaluation by the Behavioral Threat Management Team.

Please provide your name, email address, and/or phone number. A Behavioral Threat Management Team (BTMT) member may contact you to ask additional questions. If you choose to remain anonymous, it is not necessary to fill out the contact information. It is important to note that we will not be able to contact you if we need additional information about your referral.

Note that for immediate threat of violence or substantial disruption call 911.


Individual Exhibiting Behavior of Concern

Name:
PSU ID:
(if known)
Primary Affiliation:
(choose one)
Email
(if known)
Phone
(if known)
Address
(if known)

Incident/Behavior Description

Date of Incident:
Time of Incident:
Location of Incident

Please provide a detailed description of the incident(s) or situation that has caused you to file a report for possible behavioral intervention.


Person Filing Report

Name:
Telehone
Email

Human Verification


If you have an emergency, call 911.