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Behavioral Intervention Team Incident Report

Student Information

Required fields are marked with *

* Student's Full Name:

* Buff ID #:

* Student's Email Address:

Contact Information

* Your Name:

* Your Title:

* Your Phone #:

* Your Email Address:

Incident Information

* Date of Incident:

* Time of Incident:

* Location of Incident:

Detailed Description

* Please provide a detailed description of the incident using specific concise, objective language. Forward all documentation to Denese Skinner in Student Counseling Services, SSC suite 113 and/or any electronic communications/supporting documentation to biteam@wtamu.edu. Please call 806.651.2340 with any additional questions.

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