Code of Conduct Violation

Information

Your Name *

Your College Relation: *
---StudentFacultyStaffOther (Please explain in Message below)

If Other, Please Explain *

Your Phone Number [Please Enter a Valid US/Canada Phone Number including Area Code (e.g. xxx-xxx-xxxx)] *

Your Email Address *

Nature of Violation: *
---Respect for the College's MissionRespect for OthersRespect for College Officials & ResourcesRespect for Professional & Ethical ConductRespect for Self & SafetyRespect for Policy & ProcedureRespect for Communication & Use of Social MediaUnsure

Incident

Date of Incident *

Time of Incident *

Incident Location *

Message [Please provide as much information as you can, including a description of the persons involved (name, if known) and any other information that may be helpful.] *

By checking this box, you acknowledge that you have reviewed the Student Code of Conduct & Disciplinary Policy *

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