Student Conduct Certification Form

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Your Information

Name

Please enter your student ID number (if known).

DOB (YYYY-MM-DD)

Phone number

Email address (Please put in your preferred email address.)

Entity Information

Please provide information concerning the reason for filling out this form.

Name of Entity?(Required) This field is required.

Address of Entity? This field is required.

Email of Entity? This field is required.

Fax Number of Entity This field is required.

Form Consent: By submitting this form, you give permission to the University of Kansas' Office of Student Conduct and Community Standards to provide the above listed entity information regarding your non-academic misconduct record. Please type your full name below confirm you understand this and are giving consent to share any non-academic misconduct records you may have.(Required) This field is required.

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Files must be less than 2 MB. Allowed file types: gif jpg jpeg png pdf doc docx. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Your Information

Entity Information

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Submission