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Required
School Threat Assessment Team Report of Concern Form
Please answer the following questions to the best of your ability.
Today’s Date
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required
(mm/dd/yyyy)
Full Name of Student (s) of Concern and Grade Level (s):
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required
Type of concern:
(Select all that apply)
Bullying, Hazing, Intimidation
Suicide and/or Self-Harm, Depression/Isolation
Violence Toward Others
Violence at Home
Explicit Content Online
Vandalism, Weapon
Substance Abuse
Inappropriate Behavior Online
Other
Please list
Location of Incident
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required
Time (If Applicable)
Do you feel YOU are in immediate danger?*
Yes
No
Do you feel the Student Body or School Building is in immediate danger?*
Yes
No
Attachment of Video or Photographic Evidence
Max file size: 10 MB
Please describe the Concerning Behavior in as much detail as possible.
*
required
Should the School Threat Assessment Team have reason to believe that the Report of Concern was wrongfully or falsely submitted, the Becton Regional High School district reserves the right to utilize disciplinary action.