Duty to Report Arrests & Convictions Form

Please complete the information below. ALL FIELDS ARE REQUIRED.

Name as it appears in the Student Information System (SIS)

Date of incident(s):
Location(s) of incident(s) - city, state, country
Exact charge(s) filed:
Court where charge(s) filed:
Have you been found guilty?
Are you currently on probation or parole?
Enter the characters shown in the image.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.