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SHSU Students of Concern
Crisis Management Team

Faculty and Staff Reporting Responsibility

Faculty and Staff are strongly advised to report any type of behavior or threat of behavior that could threaten the well being of any student and/or may materially disrupt the Sam Houston State University Community.

If a student feels comfortable confiding in the faculty or staff member about suicidal ideation, self injurious behaviors, or materially disrupting the University community, then the faculty or staff member is strongly advised to report that information. Any information received via e-mails, list serves, blogs, blackboard postings, and social on-line networking sources (e.g., Facebook, AIM or Myspace) also should be reported as soon as possible.

A faculty or staff member should NEVER make a promise of confidentiality to a student regarding these matters.

Incident Report Form

* indicates a required field

Student’s Full Name* (First, Middle Last):

Sam ID (if available):

Student Email Address (if available):

Your First Name:*

Your Last Name:*

Your Title:*

Your Phone:*

Your E-Mail Address:*

Date of Incident (MM/DD/YYYY):*

Time of Incident:*

Location of Incident:*

Please provide below a detailed description of the incident involving the above mentioned student of concern. Be as specific as possible utilizing concise and objective language. Please forward any hard copy documentation to the Dean of Students’ Office Box 2508 Attention: Dean Yarabeck. Please contact the Dean of Students’ Office at 936-294-1785 with any additional questions.*

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About Us

The Dean of Students' Office represents the student's needs to the University administration, faculty, and various departments. Staff will assist students who have questions about any phase of campus life.

The department, in an effort to promote individual and group development of students, co-sponsors educational programs and leadership activities.

For more information on the programs offered, please contact The Dean of Students' Office.

Dean of Students' Office
Lowman Student Center
Suite 215

Box 2508
Huntsville, TX 77341-2508

Phone: 936.294.1785
1.866.BEARKAT

E-Mail: doso@shsu.edu

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SHSU Students of Concern Crisis Management Team

Faculty and Staff Reporting Responsibility

Incident Report Form

SHSU Students of Concern
Crisis Management Team