Behavioral Evaluation Threat Assessment Referral Form

Individuals wishing to contact the BETA team should complete the form at the bottom of this page. The BETA team will make every effort to respond to those requesting assistance in a timely manner. Additionally, we strongly encourage you to complete the Behavioral Evaluation Threat Assessment Form at the bottom of this page.

Behavioral Evaluation Threat Assessment Team Members

Members of the Behavioral Evaluation Threat Assessment Team meet regularly, as well as in response to requests for assistance. Depending on the particular situation, other representatives (e.g. outside mental health professionals, legal counsel) may be asked to join the Team on an ad hoc basis. In addition, the Senior Vice President of Technology and Operations is available to consult with the team as necessary. The team also consists of two licensed social workers from Heritage Behavioral Health Center.

Dr. Isaac Zuniga
Vice President of Student Success
(217) 875-7211, ext. 6253
izuniga@richland.edu

Dean Hazen
Chief of Public Safety
(217) 875-7211, ext. 6555
dhazen@richland.edu

Behavioral Evaluation and Threat Assessment Referral Form

Send a concerned persons report by completing the form below.

  • Identify the Person About Whom You are Concerned

  • Identify Yourself

  • Nature of Report

    Provide as much information as you can.
  • Date Format: MM slash DD slash YYYY

  • Observations of Appearance or Behavior

    Check all that apply

  • Issues Reported or Issues Know to You

    If a person appears ready to harm themselves or others, please immediately call 911 and report.