Student Conduct Complaint Form
Under the provisions of the Student Code of Conduct, students and appropriate university staff members who believe they have witnessed, or who believe they have been victims of violations, or who believe they may have information regarding same by students or organizations may submit a complaint to initiate an appropriate investigation.
Date Report completed:_________________________
Printed name(s) of person(s) completing this form:
1._____________________________________________________________________________________________________
_____________________________________________________ _____________________________________________ Local Address Local Phone #
2._____________________________________________________________________________________________________
______________________________________________________ _____________________________________________ Local Address Local Phone #
Date of alleged event:___________________________ Time:_____________________________
Location of alleged event:__________________________________________________________________________________
Printed names of witnesses:
_______________________________________________________ ____________________________________________ Local Address Local Phone #
2.______________________________________________________________________________________________________
________________________________________________________ ____________________________________________ Local Address Local Phone #
Description of event. Please be as detailed as possible indicating names, etc. Use additional sheets if necessary.
_________________________________________________________________________________________________________
________________________________________________________________________________________________________
_________________________________________ _______________________________________ Signature Signature
RETURN THIS COMPLETED FORM TO: THE OFFICE OF STUDENT AFFAIRS HOLMES STUDENT CENTER, ROOM 51