Behavior Intervention Team Referral Form

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Glenville State BIT Referral Form

This report is intended to notify the university of student concerns that do not require immediate intervention. If this is a campus emergency that requires immediate assistance, please contact Glenville State University Public Safety at 304-904-2041 and Emergency Services at 911. I understand that referrals from this form will be received during normal business hours (Monday - Friday, 8:00 AM - 4:00 PM) and are not monitored after hours, on weekends, or during official university holidays.

Please provide detailed information regarding the observed behavior of concern at GSU. In completing this form, you will be asked to provide your name and contact information. GSU does not accept anonymous reports. Once the report is received, a designated staff member will investigate the incident and address the issue reported. Please be aware that you and the identified other person(s) may be contacted to provide further information and/or assistance. Action taken as a result of this report may be protected by federal privacy law (Family Education Rights and Privacy Act) and therefore becomes confidential information unless otherwise specified by the named individual(s).

The incident report is ONLY to report GSU related incidents. Questions regarding the submission of this form can be directed to Trae Sprague, Dean of Student Success and Retention by email at Trae.Sprague@glenville.edu or by phone at 304-462-6054.

Faculty or staff behavior that causes concern or apprehension, but is not an immediate threat or act of violence, can also be reported to the Director of Human Resources.

These reports are received by the Behavior Intervention Team (BIT). Please describe the behavior or change in behavior, that has prompted this report. Indicate specific words, phrases and behaviors, including dates and times. If a subject used profanity, made threats, or spoke of harming him/herself, indicate specific words/phrases used. Include names(s) of campus personnel you contacted and actions taken, if any.

Background Information

Please provide detailed information regarding the incident you are reporting.

Description / Narrative

Include witness names, position, and contact information if possible.
Include participant names, position, and contact information if possible.
Glenville State University BIT Disclaimer
I understand that referrals from this form will be received during normal business hours (Monday - Friday, 8:00 AM - 4:00 PM) and are not monitored after hours, on weekends, or during official university holidays.

Please preserve any evidence, screenshots, video, text, etc. for referral. 

Please contact Glenville State University Public Safety at 304-904-2041 and/or the local police dispatch at 911 if there is an immediate risk of harm to self or others prior to submitting this form.