During Cho's last two years at Virginia Tech, several instances of his abnormal behavior, as well as plays and other writings he submitted containing references to violence, caused concern among teachers and classmates.

In the report, the panel criticized the failure of the educators and mental health professionals who came into contact with Cho during his college years to notice his deteriorating condition and help him.

In addition, the panel faulted Virginia Tech administrators in particular for failing to take immediate action after the first two deaths of Emily J. Hilscher and Ryan C. "Stack" Clark.

The family lived in Detroit, then moved to the Washington metropolitan area after learning that it had one of the largest South Korean expatriate communities in the U.S. Cho's family settled in Centreville, an unincorporated community in western Fairfax County, Virginia, west of Washington, D.C.[22] Cho's father and mother opened a dry-cleaning business.

[41][42] The Virginia Tech Review Panel report, released in August 2007, placed this diagnosis in the spring of Cho's eighth-grade year; his parents sought treatment for him through medication and therapy.

[18] Cho had contacted through phone calls and in person (by making an unannounced visit to her room) with a female student who notified Virginia Tech Police Department.

[18][62] In the preceding days, Cho had contacted a friend of Koch via AIM and wrote on her door board a line from the Shakespeare play Romeo and Juliet.

The campus police returned to the dormitory and escorted Cho to New River Valley Community Services Board, the Virginia mental health agency serving Blacksburg.

[75] However, according to Virginia law, "[a] magistrate has the authority to issue a detention order upon a finding that a person is mentally ill and in need of hospitalization or treatment."

[75] The Virginia Tech Review Panel report shed light on numerous efforts by Cho's family to secure help for him as early as adolescence.

Cho's mother, increasingly concerned about his inattention to classwork, his classroom absences and his asocial behavior, sought help for him during summer 2006 from various churches in Northern Virginia.

[48] Around 7:15 a.m. EDT (11:15 UTC) on April 16, 2007, Cho killed two students, Emily J. Hilscher and Ryan C. "Stack" Clark, on the fourth floor of West Ambler Johnston Hall, a high-rise co-educational dormitory.

[78] Within the next two and a half hours, Cho returned to his room to rearm himself; he mailed a package to NBC News that contained pictures, digital video files, and documents.

[85][86][87][88] TGSCOM Inc. shipped the Walther P22 to JND Pawnbrokers in Blacksburg, Virginia, where Cho completed the legally required background check for the purchase transaction and took possession of the handgun.

He was successful at completing both handgun purchases because he did not disclose on the background questionnaire that a Virginia court had ordered him to undergo outpatient treatment at a mental health facility.

[103] The Virginia Tech panel said that by sending the package to NBC, Cho "wanted his motivation to be known, though it comes across as largely incoherent, and it is unclear as to exactly why he felt such strong animosity.

"[18] Law enforcement investigators used ballistics tests to determine that Cho fired the Glock 19 pistol during the attacks at the West Ambler Johnston dormitory and at Norris Hall on the Virginia Tech campus.

[104][105][106] Police investigators found that Cho fired more than 170 shots during the killing spree, evidenced by technicians finding at least 17 empty magazines at the scene.

Virginia investigators learned after a review of Cho's medical records that he never complied with the order for the mandated mental health treatment as an outpatient.

In addition, Christopher Flynn, director of the Cook Counseling Center at Virginia Tech, mentioned that the court did not notify his office that Cho was required to seek outpatient mental health treatment.

Kaine also invited former Homeland Security Secretary Tom Ridge to join the panel to "review Cho's mental health history and how police responded to the tragedy.

The report concluded that the school's mental health systems "failed for lack of resources, incorrect interpretation of privacy laws, and passivity.

[125] During the time period between the two shooting events on April 16, Cho visited a local post office near the Virginia Tech campus where he mailed a parcel with a DVD inside to the New York headquarters of NBC News, which contained video clips, photographs and a manifesto explaining the reasons for his actions.

[133] In his PDF mailed to NBC, Cho states: "Children of Ishmael, Crusaders of Anti-Terrorism, my Jesus Christ Brothers and Sisters - you're in my heart.

[8][135][136][129] After pictures and images from the videos were broadcast in numerous news reports, students and faculty from Virginia Tech, along with relatives of victims of the campus shooting, expressed concerns that glorifying Cho's rampage could lead to copycat killings.

[137] Police officials, who reviewed the video, pictures and manifesto, concluded that the contents of the media package had marginal value in helping them learn and understand why Cho committed the killings.

The titles of those other video clips "are varied and hard to match with their content: 'all of You,' 'am al qaeda,' 'anti terror,' 'as time appr,' 'blood of inno,' 'congrad,' 'could b victim.'

'"[82][128][144] In his manifesto, Cho mentioned the Columbine killers Eric Harris and Dylan Klebold, and also makes references to hedonism and Christianity while expressing anger about unspecified wrongs that were done to him.

[145] In the video, Cho also railed against deceitful charlatans on campus, "rich kids," materialism, and hedonism,[146] saying: "Did you want to inject as much misery in our lives as you can just because you can?

[154][18][60] Additionally, in March 2006 at Virginia Tech's 22nd Annual Research Symposium and Exposition, Cho submitted a poem titled "Spear me down, Heaven" to the Advanced Undergraduate category.