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BOSSIER PARISH COMMUNITY COLLEGE
ACADEMIC MIS
CONDUCT STUDENT NOTIFICATION FORM
Part I. Instructor Directions: The following is to be completed by the instructor, saved, and
electronically sent to the Academic Dean.
Student Name: Student ID: _____
Course Name/Number: ________________ Instructor Name:
You are hereby notified that discipline charges may be filed against you regarding violation of the
Academic Misconduct policy as outlined in the Student Handbook under Student Services General
Policies and Procedures, Section II.
The specific charges are as follows:
Supporting information: (Describe in detail the violation(s). Give date, time, and location. Attach a
separate sheet if necessary) ________________________________________________________
The student has been notified verbally or by e-mail of the alleged charges and the intent of the
instructor to file this form. Method of notification and date: _________________________________
Part II. Dean Instructions: The following is to be completed by the Academic Dean and
electronically sent to the student.
You are directed to meet with _______________, your academic instructor, and _______________,
the Academic Dean for the academic discipline, at _________, on ________ in ____________ for a
preliminary investigation.
NOTICE: FAILURE OF THE STUDENT TO ATTEND THIS MEETING WILL BE INTERPRETED AS
AN ADMISSION OF GUILT.
For more information contact ______________________ at ______________________ .
Student Signature Date
Student Services Revised: April, 2018
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