Behavioral Concern Report

Please complete the following form to report a student exhibiting behavior of concern seeking evaluation by the Behavioral Evaluation and Threat Assessment (BETA) Team.

* Note that for immediate threat of violence of substantial disruption contact the Office of Public Safety at (518) 244-3177.

Please provide a detailed description of the incident or situation 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, Kris Gleason at BETA@sage.edu or campus mail at Residence Life, 206 Cowee Hall, Troy Campus.

Person Filing Report (items with are required)*
Name *
College Affiliation *
Phone * (5185556789)
Email *
Student Exhibiting Behavior of Concern
Student Name *
Student ID (if known)
Student email (if known)
Incident/Behavior Description

Date of Incident
Time of Incident
Location of Incident