Office of Citizenship and Conduct

Please complete the Conduct Referral Form below to alert the Office of Citizenship and Conduct to your concern. Your referral should be made in reference to an alleged violation of the Student Conduct Code. The office will work to connect with you after receiving your report to further investigate the matter.

It is important that you share your name and contact information as it is difficult to proceed without someone to talk to about the referral. Efforts are made not to disclose submitter names with accused students and organizations when possible, but accused students and organizations may be able to figure out identities on their own. The university has policies preventing retaliation. Reporting conduct concerns should be worth assigning your name to them.

Note that filing a false or misleading conduct referral is a violation of the Student Conduct Code, a matter that will be pursued by the Office of Citizenship and Conduct. Please ensure your referral is truthful.

Name of Accused Student(s) and/or Student Organization(s):*

Date of Alleged Misconduct:*

Time of Alleged Misconduct:*

Location of Alleged Misconduct:*

Primary Section of the Student Conduct Code Alleged to Have Been Violated: *

Secondary Section of the Student Conduct Code Alleged to Have Been Violated (if applicable):

Description of Alleged Misconduct:*

Intent for Completing This Conduct Referral
How are you hoping matters will proceed? Options include:

Mediation: The Office of Citizenship and Conduct works with you and the other student/organization to jointly resolve a violation of the Student Conduct Code.
Conduct Hearing: The Office of Citizenship and Conduct investigates the matter to see if a violation of the Student Conduct Code has occurred and holds students/organizations responsible for their actions.
Witness Statement: The Office of Citizenship and Conduct has asked you to submit this form to provide a written statement of your knowledge of a situation.
Response to Allegation: The Office of Citizenship and Conduct has asked you to submit this form to provide a written response to allegations made against you and/or your student organization.
Unsure: If you're not sure, please select this option. The Office of Citizenship and Conduct will reach out to you to discuss the best pathway.

*

Mediation

Conduct Hearing

Witness Statement

Response to Allegation

Unsure

Your Name:*

Your Phone Number:*

Your Email Address:*

Your Street Address:*

File Upload #1: Please upload a PDF of any additional materials if needed or requested by Citizenship and Conduct.

File Upload #2: Please upload a PDF of any additional materials if needed or requested by Citizenship and Conduct.

File Upload #3: Please upload a PDF of any additional materials if needed or requested by Citizenship and Conduct.

Today's Date: *

If you have questions about submitting this form, please reach out to:

Zac Burden, Director of Citizenship and Conduct
3100 Student Union
660-785-4141
Office of Citizenship and and Conduct
zburden@truman.edu