Delaware State University
Student Judicial System
Violation and infraction Report Form
Name of Violator
Last Name
First Name
Middle
University Identification Number:
Campus or Local Address:
Date and Time of Violation:
Location of Violation:
Please use separate form for each violation:
Type of Violation: (Please cite page number, number of violation, and state violation in Delaware State
University Student Handbook)
Statement Regarding the Violation: (Your statement should be based solely on fact, no opinion, and
contain a complete detailed account of the incident in order for the judiciary process to be carried out to the
fullest extent)
Note: If additional information is needed, use another sheet of paper and attach to form.
Please Indicate if there will be further Investigation
Names of all observing the violation
Date of this Report
Printed name of Person making the Report
Address of person making the Report
Please submit via email to JudicialAffairs@desu.edu, Suite 306, Martin Luther King Student Center 302. 857.6470