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Center for Student Rights and Responsibilities
SDSU Student Affairs

Disruption/Discipline Referral Form

For all cases of alleged violations of the Student Code of Conduct, please complete and submit this form. For more information about the judicial process and to review the Student Code of Conduct, please refer to Executive Orders 1098, and Section 41301, the Student Code of Conduct.

If you would like to discuss this incident with a Judicial Officer, and/or have questions, please call our office at (619) 594-3069.

Reporting Process:

If you believe a student has violated the Student Code of Conduct:

  1. Please report the incident by completing this form as soon as possible and submitting it to the Center for Student Rights and Responsibilities.

  2. Once you have submitted the form, please send us copies of any supporting documentation. You may either hand-delivered to SSW-1604, sent through inter-campus mail to The Center for Student Rights and Responsibilities, MC-7443, e-mailed to erogers@mail.sdsu.edu, or faxed to (619) 594-3081.

Reporting Party Information

Student Information

Student 1

   

Student 2

   

Student 3

   

Student 4

   

Other than yourself, who witnessed or had knowledge of this incident?


   (optional)


   (optional)

Please indicate any that have been contacted (if applicable):

Did you or others file a report with University Police Department?     

Incident Information


(please include date/time of incident, location, facts leading to suspicion of violation, statements made/actions observed, How did you learn about/discover the incident ?)

If alleged conduct occurred in class, please provide the:


Once you have completed the report in its entirety, to our office.

Please remember you must send us copies of all supporting documentation, either hand-delivered to SSW-1604, sent through inter-campus mail to The Center for Student Rights and Responsibilities, MC-7443, e-mailed to erogers@mail.sdsu.edu, or faxed to (619) 594-3081.