Student Professional Ethics Committee Event Form

Student ID#:
Today's Date:

Student Involved
First Name:
Last Name:
Email Address:
Class: (M1-M4)
Event Time:
Event Date:

Location of Event:

Incident Info - Please explain in your own words what occurred:

Your identity will be kept confidential unless this matter requires a hearing. If the student professional ethics committee holds a hearing on this matter, your identity will be withheld from the accused but you will have to give verbal testimony. In the event that this matter needs to go before the NSUCOM Student Progress Committee only then will your identity be disclosed to the accussed. These procedures are in accordance with the NSUCOM Ethics Committee Bylaws. Copies of all paperwork will be filed and kept for no less than five years.

Student Involved