Office of Citizenship and Conduct
Conduct Referral Form

Director of Citizenship and Conduct: Zac Burden
Office Location: 3100 Student Union
Phone: 660-785-4141
Website: Office of Citizenship and and Conduct
Email: zburden@truman.edu

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

Date and Time of Alleged Misconduct:

Location of Alleged Misconduct:

Description of Alleged Misconduct:

Type of Resolution Requested:

Mediation

Conduct Hearing

Not Sure

Not Applicable-Submitting Witness Statement

Not Applicable-Submitting Response to Allegation

Name of Submitter:*

Submitter Phone Number:*

Submitter Email Address:*

Submitter Address:*

Please upload a PDF or additional materials if needed or requested by Citizenship and Conduct.

Today's Date/Date of Referral: *