Behavioral Intervention Team (BIT) Referral Form
The BIT serves as the centralized coordinated body for discussion, intervention and assessment regarding students exhibiting worrisome or concerning behavior, which might pose a threat to self, students and/or others in the University community. All efforts will be made by the BIT, except for legal obligations, to keep information confidential.
Please fill out as completely as possible. Call University Police at 765-285-1111 or 911 for all emergencies.
Items with an
indicate a required field.
Your Contact Information
Your Status at the University
Referred Person's Information
Full Name of Referred Person
Referred Person's Email Address
Referred Person's Gender
Is Referred Person a Student?
Specific Concerns for Referral
Date of Incident
Location of Incident
How Did You Become Aware of this Concern?
Reported to you by someone else
Full Name and Contact Number of Outside Source
Concern(s) or Reason(s) for Referral? Check as many as Appropriate
Alcohol resulting in harm to self/others/both
Office disruption that included unusual/bizarrre/threatening behavior
Person has had a drastic change in behavior/appearance
Physical assault/domestic abuse
Please describe what occurred and any action you took
Please provide specifics on the incident and be as detailed as possible.
2000 W. University Ave. Muncie, IN 47306
800-382-8540 and 765-289-1241
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