Concerning or Threatening Behavior Form

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Concerning or Threatening Behavior Form

IF THIS IS AN EMERGENCY SITUATION, CALL FSU Police 850.774.2705, or 911.

Your Information: (Optional)

Your First Name:

Your Last Name:

Work Phone #:

Other Phone #:

Email Address:

Location of Incident:

Date:

Time:

Incident Location:

Individuals Involved:

Concern/Incident Information:

Provide a detailed description of the incident that prompted your concern.

Please provide an objective, concise, detailed description of concern or incident.

NOTE: PLEASE DOCUMENT OBSERVABLE BEHAVIORS AND FACTS ONLY. Avoid subjective feelings, diagnostic labels and/or derogatory information. This information will be viewed by others so please avoid inflammatory language. Here are some examples:

Student made comment to another student that “life is not worth living anymore.”
Received a student complaint that another student in class follows her to her car after class and continues to ask for her phone number after she has told him that his attention is unwelcome.
Student personality and behavior seems very different than earlier in quarter. Student now isolates herself from others and refuses to interact in small group assignments.
Student appeared very angry while making an appointment to see the Dean. The student’s body was very rigid, face was red, and fists were clenched.
Student submitted written assignment with numerous references to guns and other weapons and talked about violence as a way to get back at others.

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