Student Code of Conduct Violation Report

Student Code of Conduct Violation Form

For faculty, staff, or students to report an incident in which a student has violated the RPCC Code of Conduct outlined in the RPCC Catalog.

Student Information
Name*

First NameLast Name
LoLA#*
Email*
example@example.com
Were multiple students involved?
(Please submit individual forms for all involved parties)

Incident Information
Date and time when incident occurred:*

MonthDayYear
Date
Hour MinutesAM/PM Option
Campus Location*
Course Name
List the number(s) of misconduct, located in the Student Handbook:
Incident details summary*
(Attach additional pages if needed)
Corrective Action Taken
Desired Resolution, if any
File Upload

Cancelof
Did anyone else witness this violation?

YesNo
Witness Name

First NameLast Name
I certify that the above information is true and correct.
Signature

Clear
River Parishes Community College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. **To contact individuals designated to handle inquiries regarding non-discrimination policies, click here.
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Student Code of Conduct Violation Form