Note: Fields marked with an * (asterisk) are required.
Please complete this electronic form as fully as possible. Click into grey fields. Fields will grow as needed. The information you share may be made available to the student and should reflect only what you have observed or your specific knowledge of the incident.
Possible violations of the "Student Code of Conduct" as documented in the College Catalog. Check any that apply:
Action You Have Already Taken *Indicate any intervention or action you have already taken.
Supporting Documents - "Click Here" to email any supporting documents.
The following action is requested:
Note: This form will be submitted to David Bransky, Assistant Dean of Student Services
Ventura College, 4667 Telegraph Road, Ventura, CA 93003 (805) 289-6000