Professionalism Violation Report Form: FACULTY/STAFF

This form should be used by FACULTY/STAFF to report an alleged Professionalism violation. Note there is a different form for students to use when reporting a supposed professionalism violation. Your submission will be sent directly to the Assistant/Associate Dean of Student Affairs & Student Success (ADSA) and to the Professionalism Performance Standards Committee (PPSC) Chair. You and the accused students’ faculty advisor will be notified of the outcome of this suspected professionalism violation.

If you are a FACULTY or STAFF MEMBER submitting this form, please follow these instructions:

Review the Professional Performance Standards of the BJDSOP found here.
Prior to completing this form, if possible, faculty are encouraged to discuss your concern directly with the student. This can be the most effective and efficient way to make a student aware of unprofessional behavior and help them to improve their professional behavior.

Your Name*

First NameLast Name

Your Email*

example@example.com

Witnesses/ corroborator's Name(s) (if applicable)

Witnesses/ corroborator's email(s) (if applicable)

You are a:*

Faculty memberStaff member

Name of Accused Student(s)*

Email of Accused Student(s)*

Academic status of accused student*

Date incident occurred*

Date

Site at which incident occurred*

In person, on campusOther

If applicable, please copy and paste the specific section of the Professional Performance Standards of the BJDSOP (found here) that you believe the student has violated.

Describe the incident and any pertinent evidence*

Please attach any additional evidence, as it pertains to this incident (if applicable)

Upload a File

Did you speak to the accused student about their behavior or action?*

YesNo

If you have discussed this with the accused student, please document the Date/Time/Location of the meeting you had with the student

If you have discussed this with the accused student, please describe the conversation and how did they respond?

If you did not have a discussion with the accused student, please explain why

What is your primary goal with submitting this form?*

To document the situation, although no further action is requestedTo document the situation and request further actionOther

Do you think the alleged violation described on this form requires further action?*

YesNo

If you are requesting further action, please explain what you think would be most helpful in this situation (optional)