Bluffton University Disciplinary Referral

As you complete the Bluffton University Disciplinary Referral form, we ask that you fill in all fields as completely as possible.  Remember to record only factual information as individuals being referred will read this form.  Once you have completed all fields, hit the send button.  If you have questions or concerns, feel free to contact the Student Life Office at 419-358-3247.

 


* Required information
Date: *
Person being referred: *
Address (Hall & Room): *
Box: *
Person(s) referring (Name, Hall & Room, Box):
Time & Date of Incident: *
Location of Incident: *
Reason for Referral: *
Exact description of incident (include nature of incident and pertinent background information: *
Additional factors of which Judicial Board members should be aware:
I am willing to appear before the Judicial Board if this case is heard by the Board.
Please select one: *
Your Name: *
Copies of this form will be distributed by the Dean of Students to the person being referred and to the Judicial Board members if the referral is considered by the Board.