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

 
(Required)
 

Select a Class

Spring 2021

We will be facilitating all UBSAFER courses remotely for the spring 2021 semester.

Please register/refer as normal, being sure to indicate to the appropriate tier.

Individual sessions (Tier 3 for Spring 2021) are scheduled by appointment with Health Promotion staff. Please complete the online request form, then instruct students to monitor their UB email addresses, as a Harm Reduction Specialist will reach out to the student to schedule an appointment.

(Required)

Need Help Completing the Form?

Health Promotion

Student Life

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

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