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Referral Form

Lake Land College - Behavioral Intervention Referral Report This Behavioral Incident Report is designed to enable faculty, staff and students to voluntarily report “red flag” behaviors that may raise concerns and incidents of student misconduct at Lake Land College. An incident, in this context, is an event that does not warrant immediate intervention. In the event of an emergency or crisis situation that requires immediate intervention, call 911. The Behavioral Incident Report will provide a mechanism for responding to individual incidents and will reveal patterns of disruptive behavior of specific students. It will also provide aggregate data on the nature and frequency of disruptions at Lake Land College. This report provides a standardized method for recording observations of troublesome behaviors and for alerting staff of potential concerns. In accordance with the Student Code of Conduct and Disciplinary Procedures, information provided in the Behavioral Incident Report may also be considered in determining appropriate disciplinary action with students.

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Student Information

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Incident Information















Student Employee Other









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