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)
 
(Required)
(Required)
 
(Required)
 

Select a Class

 
 
 

Individual sessions 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