Referral Form

IF THIS IS AN EMERGENCY DO NOT USE THIS FORM.
INSTEAD, CALL 911.

The MSU Police Department will review referrals during business hours.
Time-sensitive incident may warrant an immediate response. In an emergency, please call 911.
The MSU Police Department’s non-emergency phone number is 517-355-2221.
Send a person of concern report by completing the items below.

Please note that certain professionals on the BTAT may be required to report or take other immediate action required by law based on the information submitted on the referral form.

What to Report?

Anything that raises suspicion or concern about potential violence
Acts or threats of violence
A pattern of disorderly or substantially disruptive behavior
Alarming or disturbing behavior, such as destructive or stalking behavior
Threats of physical harm to self or others
Possession of a dangerous weapon or firearm on campus

Please note: referrals are not reviewed 24 hours a day.
The MSU Police Department will review referrals during business hours.

Referral Form

Background Information

Your Legal Name

Your Position/Title

Your Phone Number

Your Email

Nature of This Report *

Date of Incident *

Time of Incident

Location of Incident *

Specific Location

Person of Concern

Please list the person of concern. Provide information in as many of the data fields as you can. In the ID Number field please include the following information if known: APID for students; ZPID for faculty or staff; a Driver’s License number for non-students.

Legal Name *

Name

Select Gender

Choose gender identity to the best of your knowledge

Select Role

ID Number

Date of Birth

Phone Number

Additional Person(s) Involved

Please list any additional people involved (excluding yourself). Provide information in as many of the data fields as you can. You may add up to 5 additional people by clicking the ADD button. In the ID Number field please include the following information if known: APID for students; ZPID for faculty or staff; a Driver’s License number for non-students.

Other Person’s Name

Other Person’s Gender

Choose gender identity to the best of your knowledge

Other Person’s Role

Other Person’s ID Number

Other Person’s Date of Birth

Other Person’s Phone Number

Other Person’s Email

Add Remove

Referral Form

IF THIS IS AN EMERGENCY DO NOT USE THIS FORM.INSTEAD, CALL 911.

What to Report?

Background Information

Person of Concern

Additional Person(s) Involved

IF THIS IS AN EMERGENCY DO NOT USE THIS FORM.
INSTEAD, CALL 911.