Reporting Form

If you are in an emergency situation that requires medical, psychological, or police services, call 911. Do not use this reporting form if an immediate response is required.

Members of the Blinn College District community may file a BIT referral regarding a Blinn College District student via this form. For reports regarding a Blinn College District faculty or staff member, contact the Human Resources Office. For an immediate emergency, call 911 or the Blinn College District Police Department at 979-361-3888.

Once the referral is received, the BIT Committee will review the information and follow BIT’s procedures to investigate the incident and address the issue(s) reported, as appropriate. Please know that you and any witnesses identified in the referral may be contacted by a BIT Committee member if additional information is needed.

BIT records are protected by the  Family Educational Rights and Privacy Act of 1974 (FERPA). Therefore, any information regarding the outcome of this referral will not be shared with you without the direct written consent of the student(s) involved.

BIT referrals are only monitored during regular office hours (i.e., Monday through Friday, 8:00 a.m. to 5:00 p.m.). Referrals made after 5:00 p.m., on weekends, or during Blinn holidays will be responded to the next business day.

If you have any questions regarding submitting a BIT referral, contact the BIT Committee directly at  bit@blinn.edu .

Please complete the form below. Reports submitted with limited information may limit our ability to follow up on an incident. Once a report is submitted online, a copy is emailed to the Behavioral Intervention Team for appropriate review and necessary action.

NOTE: Confidentiality cannot be guaranteed for reports submitted through this site. State law determines confidentiality.

Behavioral Intervention Team - Reporting Form
First Name:
Last Name:
Blinn ID Number:
Email Address:
Phone Number:
Street Address:
City:
State:
Zip Code:
Country:
Date and Time of Incident ( * ):
Nature of Referral ( * ):
Concerning Behavior
Other
Location of Incident ( * ):

Please be as specific as possible by including details regarding the person exhibiting the behavior, and the day, time, and location:

Message (20 characters minimum, 500 maximum) :


Message (0 characters minimum, 500 maximum) :

Additional Information
Were the police involved? ( * ):
Yes
No
Was a police report filed? ( * ):
Yes
No


Message (0 characters minimum, 500 maximum) :


Message (0 characters minimum, 500 maximum) :


Message (0 chars minimum, 500 maximum) :

Upload Documentation and/or Evidence
(e.g., concerning writings, email correspondence, assignments, etc.):
Supporting Documentation
( PDF ONLY)