Disruptive Student Behavior Incident Report Form
*Helpful Hints*
(909) 3893275 College Police (Emergency)
(909) 3893271 Student Health Services (Emotional Crisis Intervention)
(909) 3893355 Rebeccah Warren-Marlatt, Vice President of Student Services
1. Disruptive behavior in the classroom should not be tolerated. The instructor is responsible for
maintaining a safe and comfortable learning environment for all students. If a student is disruptive, the
instructor should immediately address the behavior by:
a. Providing the student with an oral and/or written statement that s/he has violated college policy,
b. disrupted the educational process, or violated classroom norms.
c. Indicating to the student verbally or in writing that continued disruptive behavior will result in
further documentation including possible dismissal from class.
2. An instructor may temporarily remove a student from class for up to two (2) class sessions (the current
and next regular class) for the following reasons: disruptive behavior, willful disobedience; habitual
profanity/vulgarity; open and persisted defiance of authority; persistent abuse of college personnel, threat
of force of violence. The instructor should:
a. Direct the student to see the Vice President of Student Services before returning, and notify the
Vice President of Student Services by phone within two hours after the end of the class, and by
email/writing within 24 hours of the temporary removal of the student from class.
b. Provide the Vice President of Student Services with documentation regarding the student’s
behavior, including written and verbal warnings, policies violated and any previous actions taken.
3. In cases that involve threat or violence, College Police should be notified immediately. At the earliest
opportunity, an incident report should be submitted to the Vice President of Student Services.
1. Direct the student to stop the behavior.
2. If the situation appears dangerous, immediately contact College Police at (909) 3893275.
3. Complete the Incident Report Form, providing the student’s name (if you know it) or a physical
description and send it to the Vice President of Student Services.
4. If a pattern of disruptive behavior by the student is documented by various departments, the
Vice President of Student Services will follow up with the student and disciplinary action may be taken.
Incident Date/Time/Location: _________________________________________________________________
(Please include course name, if applicable. Ex.: 12/01/13, 1:30 p.m., CL-215, ENGL 101)
Disruptive Student Name (s): ________________________________________________________________
(Please include Last, First and Student ID Number)
Witness Name: _________________________________________________________________
(Please include Last, First, and Student ID Number, if applicable)
Campus Personnel Notified: _________________________________________________________________
Your Name/Title: _________________________________________________________________
Your Contact Information _________________________________________________________________
Please describe, in as much detail as possible, the specific behaviors observed. To the best of your ability, report
the exact words, phrases and interactions you observed. If applicable, describe any injury or damage to person(s)
or property. Include name(s) of campus personnel you contacted and actions taken, if any.
Original: Rebeccah Warren-Marlatt, Vice President of
Student Services
Copies: Dr. Cheryl Marshall, President
Division Dean of Instruction, if applicable
Pierre Galvez, Chief of Police,
San Bernardino Community College District
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