Behavioral Intervention Letter Template printable pdf download

ON LETTERHEAD

PERSONAL AND CONFIDENTIAL

DATE

STUDENT NAME

ADDRESS

HAND DELIVERED

Dear STUDENT NAME,

The (SCHOOL NAME) is concerned about the well being of all of its students, faculty, and staff. I have received

information that you may have been involved in an incident that caused some concern about your safety, health,

and/or well-being in the community; specifically, that you may have engaged in or threatened to engage in a self-

injurious behavior. I sincerely hope that your situation is improving. The (SCHOOL NAME) has policies regarding

the safety, health, and/or well-being of its students, faculty, and staff. These policies address self injurious

behaviors, as well as any activities that are disruptive to the mission of the university.

Per our policies, this letter is to give you notice that you must immediately attend an assessment by the Counseling

Center on (DATE AND TIME OF APPOINTMENT). The Center is located at (ADDRESS). They can be

reached at (PHONE) on Monday-Friday, from 8:30am-5:00pm. You will need to take this letter with you to your

first meeting, and should arrive at the Center at (15 minutes prior to appointment for intake paperwork). If you

feel you would like to meet with a counselor at the Center sooner, please call them and tell them that you need to be

seen on an “emergency basis,” and that you received this letter. Should you need emergency assistance, please call

911.

The total assessment will conclude after four meetings at intervals to be determined by a counselor at the Center.

After your initial assessment and as you progress through the three subsequent sessions, the Behavioral Intervention

Team will discuss your situation and make a determination that takes into consideration your best interests as well as

the best interest of the university community. Your assessment counselor will explain these and any other exceptions

to confidentiality, but you may also go to (WEBSITE) for more information.

If you have any questions or concerns, or you believe you have received this letter in error, please contact me at

(PHONE). You are not required to contact me if you attend your appointments as requested.

Sincerely,

Chair, Behavioral Intervention Team

CC:

Behavioral Intervention Team

Behavioral Intervention Letter Template