Student Statement Form

Date
Time
Check One
 Victim       Witness
First and Last Name
Student ID Number
   
Local Address  
Residence Hall and Room No.
(if on campus)
Street
City
State
Zip
Telephone Number
(please include area code)
Cellular Phone
VUU Email Address
 @vuu.edu
   
Permanent/Home Address  
Street
City
State
Zip
Permanent Telephone Number
   
Statement

By checking this box, I acknowledge my understanding that violation(s) of the University Code of Conduct may be referred to the Campus Judicial System. Therefore, it is my responsibility to obtain information about the status of my complaint by accessing my VUU email account. I further understand that I may contact the hearing officer at judicialaffairs@vuu.edu. In the event that the VUU email system cannot be accessed, it is my responsibility to contact the Hearing Officer through the Office of Student Affairs (Henderson Student Center) within 48 hours to obtain such information. I understand that the Office of Student Affairs is not required to contact me by phone or letter.


   

 

 

 
Last Revised: April 15, 2004 - Publisher: VUU Office of Student Affairs
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