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GLENDALE COMMUNITY COLLEGE

STUDENT CONDUCT DISRUPTION/DISCIPLINE REPORT

Use this form to report disruptive student behavior and/or request disciplinary action

 

 

Student Name:

Course/Incident Location:

Today's Date:

 

 

Student ID #:

Date/Time:

Employee Name:

Phone Number:

Dean of Student Affairs
Dean of Instruction
Public Safety

Severe or repeated verbal disruption or obstruction of teaching, college activities / services

Knowingly furnishing false information to the college and its officials

Abuse of college computers/time, i.e., e-mailing inappropriate material, use of someone’s password

Forgery, falsification, alteration, or misuse of college documents, records or ID

Report of sexual harassment of another student or college employee

Report discrimination by a student or college personnel 

Academic dishonesty, such as cheating or plagiarism

Other (describe specific academic misconduct)

If other, please describe below:
 

Physically threatening or fighting with another student or college employee

Attempted or actual theft of and/or damage to college or personal property

Will not leave room/area when requested to do so

Possession or use of firearms or other weapons, explosives, dangerous chemicals, alcohol or illegal drugs on college property

Unauthorized entry and/or use of college facilities

Use of college computers to view/send /receive pornography

 

Please describe the incident or behavior:

Describe steps taken by you to resolve the problem:

Follow-up action requested (check as many as are relevant):
For your information only. No follow-up needed

Please call and advise if this student has a history of trouble

Please call with suggested interventions

Refer student to counseling

Please see student regarding disciplinary problems