UB SAFER Referral and Registration Form

Refer a student — or register yourself — for the UB SAFER intervention program. You can use this form for Tier 1, Tier 2 or Tier 3 sessions.

Timeliness is important. We cannot admit anyone after the group session begins.

Student Personal Information

(Required)
 
(Required)
 

Referral Information

 
 

Select a Class

Please select a class from one of the following tiers.

Tier 1 - A Group Class for Lower-Risk Alcohol and Other Drug Use

During this session, students will examine their alcohol and/or marijuana use, review tips for reducing risks related to substance use, explore how to be a helpful bystander in these situations and affirm positive strategies that they are already using.


Tier 2 - A Group Class for Higher-Risk Alcohol and Other Drug Use

During this session, students will complete a brief written assignment, then explore their reasons for usage and ways to reduce risk as they learn more about alcohol and marijuana use; through self-reflection and goal setting, students have the opportunity to explore alternatives to their behavior in order to decrease negative consequences related to alcohol and other drug use.


Tier 3 - An Individual Session With a Wellness Education Services Substance Abuse Specialist

During this session, the student will complete a brief written survey assignment, then explore their reasons for usage and ways to reduce risk as they learn more about alcohol and marijuana use in a one-on-one session with a professional. Through self-reflection and goal setting, students have the opportunity to explore alternatives to their behavior in order to decrease negative consequences related to alcohol and other drug use.


Scheduled by Appointment

Individual sessions (Tier 3) are scheduled by appointment with Wellness Education Services staff. Please complete the online request form, then instruct students to contact the Substance Abuse Specialist to make an appointment:

University at Buffalo
114 Student Union, North Campus
Buffalo, NY 14260

Phone: (716) 645-2837; Fax: (716) 645-6234

If this is a Tier 3 referral, I have notified the student to contact Wellness Education Services to schedule their session.
If this is a Tier 3 referral, I have notified the student to contact Wellness Education Services to schedule their session.
 
 
Please contact Marla McBride at 645-2837, ext. 2 to discuss your referral further.

Need Help Completing the Form?

University at Buffalo
114 Student Union, North Campus
Buffalo, NY 14260

Phone: (716) 645-2837; Fax: (716) 645-6234