Student Code of Conduct Violation Reporting Form

If this concern requires immediate attention, please contact Campus Police at (618) 985-2828, extension 8218. They are available 24/7 to provide assistance in urgent or emergency situations.

Please use this form to report observed or suspected violations of the student Code of Conduct. Please provide as much detail as possible. Submissions will be reviewed promptly. If you have any questions or concerns, please contact the Assistant Provost for Student Affairs: Rachel Sveda-Webb.

Reporting Party: *

• JALC Employee
• Non-Employee Third Party
• JALC Student

Reporting Party Information

Name: *

First

Last

Department/Title: *

College Email *

Email

Confirm Email

Email *

Email

Confirm Email

Volmail: *

Email

Confirm Email

Phone (optional):

Student Information

Student Name: *

First

Last

Student ID (optional):

Violations Being Reported

It is my observation that the above listed student has committed or may have committed the following violation(s) of the Student Code of Conduct: (Check all that apply)

• Acts of Dishonesty Outside of the Classroom
• Alcohol, Drug, or Tobacco
• Disruption or Interference with College Operations
• Facilitation of Misconduct
• Gambling
• Hazing
• Misuse of Communication, Electronic Devices, and Technology
• Non-Compliance with Authority
• Physical Abuse
• Policy Violation
• Sexual Misconduct
• Theft and Property Damage
• Unauthorized Building Occupancy
• Verbal Abuse, Bullying, and Cyberbullying
• Violations of Disciplinary Terms
• Weapons Possession

It is my observation that the above listed student has committed or may have committed the following violation(s) of the Student Code of Conduct: (Check all that apply)

• Academic Dishonesty
• Acts of Dishonesty Outside of the Classroom
• Alcohol, Drug, or Tobacco
• Disruption or Interference with College Operations
• Facilitation of Misconduct
• Gambling
• Hazing
• Misuse of Communication, Electronic Devices, and Technology
• Non-Compliance with Authority
• Physical Abuse
• Policy Violation
• Sexual Misconduct
• Theft and Property Damage
• Unauthorized Building Occupancy
• Verbal Abuse, Bullying, and Cyberbullying
• Violations of Disciplinary Terms
• Weapons Possession

If you are reporting sex-based misconduct, please use the Title IX reporting form.

Details Regarding the Violation(s)

Date of Incident: *

Location of Incident: *

Description of Student Behavior: *

Upload documentation of any communication with the student regarding the violation(s) (optional):

Click or drag files to this area to upload. You can upload up to 3 files.

Upload any supporting documents related to your report (optional):

Click or drag files to this area to upload. You can upload up to 3 files.

Sanctions Imposed

The following sanction(s) have been imposed:

Minor Sanctions: Available to ALL College employees (check all that apply)

• Educational Intervention
• Temporary Dismissal (up to 24 hours)
• Verbal Warning
• Written Warning

Educational Intervention – Provide a description of the assignment or activity: *

Educational Intervention – Deadline to completion: *

Temporary Dismissal (up to 24 hours) – Provide a description of the course, activities, or location relevant to the temporary dismissal: *

Verbal Warning – Provide a brief description of the warning: *

Written Warning – Provide a brief description of the warning: *

Intermediate Sanctions: Available to Directors, Deans, Assistant Provosts, the Provost, the President, or the Student Complaint and Conduct Committee.

• Administrative withdrawal from course(s)
• Course Failure
• Limited access
• Loss of privilege(s)
• No contact order
• Referral
• Restitution
• Short-term suspension (up to 3 business days)
• Semester suspension

Administrative withdrawal from course(s) – Course prefix(es) and number(s): *

Course Failure – Course prefix(es) and number(s): *

Limited access – Location(s), course scheduling option(s), or course modality student has been restricted from: *

Limited access – Time period of restriction: *

Loss of privilege(s) – Privilege(s) student is restricted from: *

Loss of privilege(s) – Time period of restriction: *

Loss of privilege(s) – Terms that must be fulfilled before restriction is lifted: *

No contact order – Student is to have no contact with: *

No contact order – Time period of no contact order: *

Referral – Resource or service student is required to utilize: *

Referral – Deadline for completion: *

Restitution – Service, monetary amount, or material replacement student: *

the with: with

Restitution – Deadline for completion: *

Short-term suspension (up to 3 business days) – Provide a description of the course, activities, or location relevant to the short-term suspension: *

Short-term suspension (up to 3 business days) – Timeframe for suspension: *

Semester suspension – Provide a description of the course, activities, or location relevant to the semester suspension: *

Semester suspension – Semester of suspension: *

Severe Sanctions: Available to the Provost or President.

• Long-term suspension
• Expulsion

Provide a description of the course, activities, or location relevant to the long-term suspension: *

Timeframe for suspension: *

No Sanction:

• No sanction has been imposed. I am submitting this form to report a potential violation for review.

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