CSUB BART Reporting Form

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Behavioral Assessment and Response Team Incident Reporting Form

Person report is about:

Student/Employee Full Name (First, Middle, Last):

Student ID/Employee Department (if available):

Student ID/Employee Email Address (if available):

Person making the report:

Your Name:

Your Status: Faculty Staff Student

Your Phone:

Your Email Address:

Date of Incident:

Time of Incident:

Location of Incident:

Incident Reported Elsewhere:

Please provide a detailed description of the incident using specific, concise, and objective language. Forward all the supporting documentations to the Student Conduct Office at 44 CAF. Please call (661) 654-2680 with any additional questions.

To the extent possible, the identity of the reporting party and information provided will remain confidential, but absolute anonymity and privacy cannot be guaranteed. The University may have an obligation to use the information in subsequent proceedings. If you have any concerns about safety or possible retaliation because you made a report, please inform the University Police Department.

CSUB Behavioral Assessment and Response Team

California State University Bakersfield

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Behavioral Assessment and Response Team Incident Reporting Form