UPDATED: June 11, 2019
Violation of Student Code of Conduct Report Form
Purpose:
For faculty, staff or students to report an incident in which they believe a student violated the RPCC Student
Code of Conduct. (Related Policy: Student Code of Conduct, found in 2019-2020 Catalog).
Reporter’s Information
Reporter’s Name: ___________________________ Lola Number: _____________________________
Phone Number: __________________ Email Address: _____________________________
I am a (check one): □ Faculty Member □ Staff Member □ Student
Incident Information
Place of Incident: _____________________________________________________________________
Date of Incident: ____________________ Approximate Time of Incident: _____ am/pm
Student Information
Name of Student: __________________________ Lola Number (if known): __________________
Email address of student (if known): _______________________________________________________
Phone number of student (if known): _______________________________________________________
