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Report

WILDCAT CARE SUBMISSION FORM

Campus with students out front

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Report Concern

This is an Intervention and Referral Request form that is submitted to the Campus Security/Behavioral Care Team.

Person Providing Information

Name

First Name

Last Name

Your relationship to the person of concern

Phone

Email

Address

Street Address

Address Line 2

City

Zip / Postal Code

State

The Person of Concern Information

Name (person of concern)

First Name

Last Name

Identifiers

Gender

Approximate Age

Possible Nickname

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

Location

Campus

Building

Room

Class Date

Class Time

Immediate Needs

Check all that apply

Assistance with Housing
Assistance with Clothing
Assistance with Food

TYPE OF CONCERNING BEHAVIOR

Check all that apply

A significant change in personal hygiene or appearance
A significant change in energy level
Change in mood, personality or behavior
Withdrawn –Complaints of fatigue
Inability to focus or concentrate
Unusual or erratic performance, speech behaviors
A significant change in weight
Threat of self-harm
Visible Injuries - cuts, burns, etc.
Farewell statements alluding to not ever seeing people again
Tearfulness or repeated episodes of crying
Giving away prized possessions
Feeling of hopelessness
Expressions of worthlessness
Difficulty controlling emotions
Academic or workplace performance concerns
Excessive absenteeism / missing scheduled classes or appointments
Tardiness to class or appointments
Comments related to sleeping issues/nightmares
Direct threats toward an individual or individual
Displays unprovoked anger, aggression or hostility
Unusual writing or drawings
Demanding
Inappropriate outburst or reactions
Intimidating
Preoccupation with violence
Expressions of worry or anxiety
Feeling suspicious of others
Suspected drug or alcohol abuse
The odor of an alcoholic beverage
Cultural factors
Problems making friends
Stares inappropriately at others
Invades personal space of others
Makes unwanted physical contact
Abusive to animals
Preoccupied with fire

Other

Please indicate selections from the relevant category/categories.

These are circumstances associated with the person of concern that have been reported or known to you personally.

Check all that apply

Is not engaged in seeking treatment for a diagnosed health condition
History of alcohol/drug abuse
Has suffered personal or financial loss
Destruction of property
Fire setting or arson
Suffered childhood abuse or neglect
Suffered sexual assault or abuse
Committed sexual assault or abuse
Victim- history of relationship/domestic violence
Offender- history of relationship/domestic violence
Fantasy of harming people
History of planning a violent event
Fascination with weapons
Owns or has access to weapons
Has made homicidal statements
History of violent, reckless or antisocial behavior
History of suicide attempt
Other (Please provide details below)
None of these apply

Indicators & Behaviors of Suspected Terrorists

Check all that apply

Breach/Attempted Intrusion - Unauthorized personnel; attempting to enter or actually entering a secured area.
Misrepresentation - Presenting False information or misusing insignia, documents, and documents, and/or identification misrepresents one's affiliation as a means of concealing possible illegal activity.
Theft/Loss/Diversion - Steeling or diverting something associated with a facility/infrastructure for the purpose of committing an act of terrorism.
Cyberattack – Compromising or attempted to compromise or disrupt an organization’s information technology infrastructure.
Expressed or Implied Threat – Communicating a spoken or written threat to commit a crime that will result in death or bodily injury to another person or persons or to damage or compromise a facility.
Aviation Activity – Learning to operate or operating an aircraft in a manner that poses a threat of harm to people or property.
Eliciting Information – Questioning individuals at a level beyond mere curiosity about events, facilities, and related security procedures.
Testing or Probing of Security – Deliberate interactions with people or installations for the purpose of revealing security capabilities or weaknesses.
Recruiting/ Financing – Providing direct financial support and or assistance to a terrorist group.
Photography- Taking pictures of facilities or buildings in an unusual manner that would arouse suspicion in a reasonable person.
Observation /Surveillance – Demonstrating unusual prolonged interest in a facility beyond casual or professional interest.
Material Acquisition / Storage – Acquiring and or storing unusual quantities of materials for use in unlawful activities.
Acquisition of Expertise – Attempts to obtain or conduct training in security concepts, military weapons or tactics for other than lawful purposes.
Weapon Collection / Discovery- Collection of unusual amounts of weapons, ammunition, explosives, or toxic chemicals for other than lawful purposes.

Report

Contact Us

Bishop State Community College

351 N Broad St
Mobile, AL 36603

Ph: (251) 405-7000

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