If you are human, leave this field blank.
Identify the person about whom you are concerned
His or her name
His or her email address
His or her phone number
How do you know this person?
By identifying yourself, the Threat Assessment Team will be able to more fully investigate and respond to your concerns. Without your identifying information, we may not have enough information to address the situation you have described. Anonymous reports will be pursued, but the ability of the Threat Assessment Team to respond may be limited. Thank you for your referral.
Your first name
Your last name
Your email address
Your phone number
Nature of Report
Please provide as much information as you can.
Threat of Self-Harm
Decline of Function
Date of incident
Description of Concern or Incident
Observations of Appearance or Behavior
Changes for the worse
Change of weight
Emotional Signs of Distress:
Extreme mood swings
Shows no emotions
Seems to be seeing or hearing things
Physical Signs of Distress:
Burns or cuts
Behavior in Groups/Class:
Often at odds with others or picks fights
Other Observations of Appearance or Behavior:
Issues reported or issues known to you (If a person appears ready to harm themselves or others, please immediately call 911 and report.)