Situation of Concern Form

In the event that there is an immediate emergency, call 911 and/or go to the nearest emergency room.

Additionally, HELPline offers 24-hour crisis counseling and can be reached at 256-716-1000 or 1-800-691-8426.

All reports to the Calhoun Threat Assessment/Behavioral Intervention team will trigger an immediate email confirmation. A personal email from a threat assessment/behavioral intervention team will follow once an initial review of the report has been completed.

Campus police may be contacted directly at 256-890-4711 or 4711 from any extension on the Huntsville campus, 256-306-2575 or 2575 from any extension on the Decatur campus, and (256) 260-4305 or 4305 from any extension on the ACA campus.
Please describe the threat, including names, events, locations, etc: *
Calhoun campus location associated with the threat:*

Decatur CampusHuntsville CampusAlabama Center for the ArtsOther
Your Full Name*

First NameLast Name
E-mail*
Your Status:*

StudentFacultyStaffOther
Your relationship to the person of concern

ClassmateInstructor/StaffNo RelationRelativeSelf
Please provide method(s) for us to contact you: (For example, please leave any combination of your home phone, cell phone, multiple email addresses, etc.)*
The Person of Concern's Information
Name

First NameLast Name
Possible Nickname
Gender
Approximate Age
If the person is in a class with you or you know of a class that they are taking, please include the following:
Class Location

DecaturHuntsvilleACA
Building
Room
Date and Time of Day
Immediate Needs (Check all needs that apply)

Assistance with clothingAssistance with foodAssistance with housing
Type of Concerning Behavior (Check all behaviors that apply)

Abusive to animalsAcademic or workplace performance concernsChange in mood, personality or behaviorComments related to sleeping issues / nightmaresCultural factorsDemandingDifficulty controlling emotionsDirect threats toward an individual or individualsDisplays unprovoked anger, aggression or hostilityExcessive absenteeism / missing scheduled classes or appointmentsExpressions of worry or anxietyExpressions of worthlessnessFarewell statements alluding to not ever seeing people againFeeling of hopelessnessFeeling suspicious of othersGiving away prized possessionsInability to focus or concentrateInappropriate outburst or reactionsIntimidatingInvades personal space of othersMakes unwanted physical contactOdor of alcoholic beveragePreoccupation with violencePreoccupied with fireProblems making friendsSignificant change in energy levelSignificant change in personal hygiene or appearanceSignificant change in weightStares inappropriately at othersSuspected drug or alcohol abuseTardiness to class or appointmentsTearfulness or repeated episodes of cryingThreat of self-harmUnusual or erratic performance, speech behaviorsUnusual writing or drawingsVisible Injuries - cuts, burns, etc.Withdrawn –Complaints of fatigue
Circumstances of concern

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

Committed sexual assault or abuseDestruction of propertyFantasy of harming peopleFascination with weaponsFire setting or arsonHas made homicidal statementsHas suffered personal or financial lossHistory of alcohol/drug abuseHistory of planning a violent eventHistory of suicide attemptHistory of violent, reckless or antisocial behaviorIs not engaged in seeking treatment for diagnosed health conditionNone of these applyOffender- history of relationship/domestic violenceOther (Please provide details below)Owns or has access to weaponsSuffered childhood abuse or neglectSuffered sexual assault or abuseVictim - history of relationship/domestic violenceOther
Please Enter Additional Details
Indicators & Behaviors of Suspected Terrorists (Check all indicators that apply)

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

The Person of Concern's Information