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602.787.7668
Administration Bldg.
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Maricopa Governance Online Policy Manual
The district student disciplinary policy can be found at the district website at: Student Rights and Responsibilities Adobe pdf format.
Responding to Disruptive or
Threatening Student Behavior:
A GUIDE FOR FACULTY AND STAFF
 MSWord format (176Kb)
PVCC Disruption/Discipline Report
Fill out the Online Disruption/Discipline Report
OR
Download the PVCC STUDENT CONDUCT DISRUPTION/DISCIPLINE REPORT
MSWord format (44Kb)
This document can be downloaded and then filled out as a form in MSWord. Once completed save the document using a unique file name and then email the completed form to the Dean of Student Affairs.
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sample page of this form
Paradise Valley Community College
STUDENT CONDUCT DISRUPTION/DISCIPLINE REPORT
Use this form to report disruptive student behavior and/or disciplinary action
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| Student’s Name __________________________ |
Student ID# _________________ |
| Course or Incident Location ______________ |
Day/Time _______________________ |
Date _____________ Faculty or Staff Name ___________________ Phone ____________
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| The above-named student has exhibited the following behaviors or actions (check as many as apply): |
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Disruption or obstruction of teaching, administration, college activities |
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Knowingly furnishing false information to the college and its officials.
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Willful disobedience or defiance toward college personnel.
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Physically threatening another student/college personnel.
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Forgery, falsification, alteration or misuse of college documents, records, or ID |
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Cheating or plagiarism. |
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Unauthorized use of anther computer user’s identification and password. |
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Unauthorized entry and/or use of college facilities. |
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Use of computing facilities to send obscene or abusive messages. |
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Will not leave room when requested.
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Attempted or actual theft of and/or damage to property. |
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Possession or use of alcohol or illegal drugs on college property.
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Disorderly, lewd, indecent, or obscene conduct. |
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Public Intoxication.
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Fighting with another student.
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Verbally threatening another student/college personnel.
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Sexual Harassment of another student or college personnel. |
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Possession or use of firearms, explosives, dangerous chemicals, or other weapons on college property. |
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Theft or other abuse of computer time/usage
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Describe the behavior or incident (use additional sheets if necessary).
Follow-up action requested (check as many as are relevant):
For your information only. No follow-up requested.
Please call and advise if this student has a history or trouble.
Please call with suggested interventions.
Refer student for counseling.
Please see student for disciplinary action.
EMERGENCY: If help is needed immediately, call College Safety (77900) or hand carry this form to Safety.
| Distributions: |
| Return Original and 1st copy to Dean of Student Affairs- Administration Bldg. |
| 2nd Copy to student |
| 3rd Copy for your information / file |
Date Received: ___________________________
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