ST. AUGUSTINE COMMUNITY COLLEGE

STUDENT CONDUCT / DISCIPLINE REPORT

Use this form to record disruptive behaviour / disciplinary action.

Student Information

Name of Applicant

Date of Birth

School Attended

Period Attended (From)

Period Attended (To)

Present Class

Form Seeking Admission Into

Behaviours / Actions Observed

Suspension / Expulsion

Has the student ever been suspended from school?

Yes No

If yes, explain briefly

Expulsion from school (Brief summary)

Other Pertinent Information / Comments

Comments relevant to the applicant

Certification

Principal Signature

Date

School Stamp

The contents of this document are confidential. Please seal this report in an envelope and place school stamp and signature over the seal to prevent tampering.