Disclosures

Student ID*

First Name*

Last Name*

On what date did the incident/charge/party to lawsuit happen?*

What are the specific details of the incident/charge/party to lawsuit?*

Where did it occur (city/county and state)?*

What is the disposition of the incident/charge/party to lawsuit?*

If you failed to disclose in the appropriate timeframe of 10 days, what is the reason that you did not disclose as required?*

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