Intervention and Referral Request

IF THIS IS AN EMERGENCY, DO NOT USE THIS FORM.

CALL (205) 856-6093

Behavioral Care Team Intervention And Referral Request

Intervention and Referral Request

  • Person Providing Information

  • The Person of Concern Information

  • If the person is in a class with you or you know of a class that they are taking, please include the following:

  • :
  • TYPE OF CONCERNING BEHAVIOR

  • Please indicate selections from the relevant category/categories. Circumstances associated with the person of concern that have been reported or known to you personally.