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Concerning Behavior Referral Form


Important: If there is an immediate threat to safety of yourself, the potential student concern, the campus, etc. please immediately contact emergency services at: 9-1-1.

This form is one way that Metropolitan State University members can share concerns about a current student to help maintain a healthy and safe campus learning environment. Please be as specific as possible when filling out this form so that the most appropriate resources can be provided to the potential student of concern that you are referring.

Once you have filled out this form to your best ability, your referral will be sent to either the Behavioral Intervention Team (BIT) or CARE Team. The BIT or CARE Teams may contact you for follow up information or contact the student directly to help empower them in their academic and student success journey. Your name will not be revealed to the potential student of concern unless you would like it to be.

Completing this form is not for reporting academic or conduct-related concerns. For academic and conduct related concerns, go to: http://cm.maxient.com/reportingform.php?MetroStateUniv&layout_id=2

Thank you for your submission.

The BIT and CARE team currently operate during regular business hours (8:30-5:00pm) Please contact Metro State CARES support line 651-793-1568 after hours.

Tell Us About You:

This form may be filled out anonymously by simply not including your personal information, but we encourage you to share your name and role as it better enables us to respond to the situation. If you do share your name, please also be sure to include your contact phone number. You will receive a follow up phone call from a BIT member within 24 hours.

 
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Who Are You Concerned About?

Involved party 1

Tell Us About Your Concerns

Please check any behaviors below that have led you to be concerned about the individual involved. If no boxes apply, please use the text box to describe your concerns in detail:(Required)
You must make at least one selection.
This field is required.
Has this student's behavior caused you concern for your own personal safety? (Please check all statements that apply)(Required)
You must make at least one selection.
This field is required.
Please indicate below how soon you need to be followed up with regarding this matter(Required)
You must make at least one selection.
This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission