Click here to download form

INSTRUCTIONS (if using Mozilla Firefox):               

1.       Click SAVE

2.       Select Desktop or My Documents

3.       Click SAVE

4.       Click Open

5.       Complete all required fields:

                        Instructor                                                           

                        Date                                                     

                        Department                                      

                        Student                                                               

                        Student ID                                         

                        CRN                                                      

                        Prefix & Course Number

                        Course Title

                        Violation

                        Brief Explanation

                        Course-Related Penalty

6.       Instructor’s Signature and Date

7.       Obtain Department Chair’s Signature and Date

8.       The Department Chair submits the signed original to the Office of the Registrar, McCastlain 112

INSTRUCTIONS (if using Internet Explorer):               

1.        Click SAVE

2.       Select Desktop or My Documents

3.       Click SAVE

4.       Click OPEN                         

5.       Complete all required fields:

                        Instructor                                                           

                        Date                                                     

                        Department                                      

                        Student                                                               

                        Student ID                                         

                        CRN                                                      

                        Prefix & Course Number

                        Course Title

                        Violation

                        Brief Explanation

                        Course-Related Penalty

6.       Instructor’s Signature and Date

7.       Obtain Department Chair’s Signature and Date

8.       The Department Chair submits the signed original to the Office of the Registrar, McCastlain 112