Student Criminal Charge Report

Student Criminal Charge Report
Shenandoah University pharmacy students who acquire criminal charges must report the charges within 72 hours or immediately upon return to school, whichever comes first. Charges to be reported include, but are not limited to, misdemeanors, including serious traffic violations, and any felony offenses.

This form will be submitted to the Office of Student Affairs.

Upon filing, the University reserves the right to verify accuracy of the information through public officials or other authorized agents.

When the legal process is completed, it is the student’s responsibility to notify the Assistant/Associate Dean for Student Affairs of the outcome within 72-hours or immediately upon return to school, whichever comes first.

Failure of student to report any new criminal charges or convictions when they occur (as outlined above) may result in dismissal.
Name*

First NameLast Name
E-mail*
Campus: *

Northern VAWinchester
Class: *

P1P2P3P4
Date of Charge(s)*

MonthDayYear
Criminal Charge(s)*
This Charge is a:*

MisdemeanorFelonyOther
Jurisdiction (City, County, State where incident occurred):*
Explanation of Charge(s): *
Court Date (if applicable):

MonthDayYear
Should be Empty: