Online Surveys and Forms

Student Conduct Incident Report (SCIR)

Introduction:

Please enter your email address in the "Copy to your Email Address" box to receive a confirmation copy of your submission. You may add an additional recipient in the "Copy to additional e-mail address" box. Required fields are marked with an asterisk (*). You may wish to view the Student Conduct information in the CCS Catalog.

Instructions:

Please email any supporting documentation to the following contacts:

Connan Campbell: Connan.Campbell@scc.spokane.edu

Timothy Orton: Timothy.Orton@scc.spokane.edu

* Enter your email address to receive a copy of this form:

Copy to additional email address:

STUDENT INFORMATION

* Student's Name: * ctcLink ID: * Phone:

* Email Address:

LOCATION OF INCIDENT

* Date/time of incident: * Location of incident: (campus, building/room number)

REPORTING PERSON

* Your Name:

* Status:

* Office/Division: Mail Stop: Phone:

IF FACULTY, please respond to the following:

Action taken to date:

Warning

Suspension from class

If you checked "Suspension", please complete the following fields (otherwise skip).

Number of Days:

Start date: End date:

Date Notified:

THE INCIDENT/ALLEGATION

Important Notes

A student conduct officer assigned to this report may contact you with questions about the incident(s) described below. Every effort will be made to keep the individual submitting this report informed of the actions and decisions made, but care is also necessary to insure an appropriate level of confidentiality on behalf of the student. If this is an academic dishonesty incident, please email any additional information that might help (e.g. class syllabus, assignments) to the contacts above.

Is this report being submitted to make the student conduct office aware of the student's behavior and no other action is necessary?

Yes

Description of Incident:

Please describe specific behaviors observed, words used, time and dates of incidents. Email additional pages as necessary to the contacts above.
Please include any prior interaction you have had with the individual(s) involved, any actions/steps you have taken to address behaviors, and any actions taken to address this particular incident (if applicable).
Please also include anything that might help the student conduct officer better understand the individual or circumstance. If there are witnesses to the incident please list them by name and student ID number (if known) above your narrative.

Leave this field blank: