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)

Have you ever been convicted of (or is any charge now pending against you for) any violation of federal, state, local, or international law? You do not need to report minor traffic violations that did not result in injury to others. Charges related to reckless driving and driving under the influence of alcohol or other drugs are not "minor traffic violations" and must be reported.
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?