Intervention Request Form

The Intervention Request Form provides employees an opportunity to share a concern about a students academic progress, wellness, or safety. In case of an emergency, dial 911, or call Penn State Berks Police Services at 610-396-6111. (Police pager after business hours: 610-396-4822).

Thank you for sharing your concern with us. The name of the person reporting will not be shared with the student. Receipt of notification will be provided.

Complete any student information that is known.
Actions taken to date (Check all that apply)
Referred Student to the following resources (check all that apply)