BETA Team Form
Complete the following form to report a student exhibiting behavior of concern and to seek evaluation by the Behavioral Evaluation & Threat Assessment Team.
Person Filing Report (items with * are required)
Name of person reporting incident:
Student Exhibiting Behavior of Concern
Name of student
Student ID ( if known)
( if known )
Date of incident:
Time of Incident
Location of Incident
Please provide a detailed description of the incident that has caused you to file a report for possible behavioral intervention. Additional supporting material such as electronic mail or other documents may be sent separately to BETA Team chair Dr. Boomer W. Appleman, by email at firstname.lastname@example.org or at Administration Building Room 103.
Do Not Fill This Out