Student Conduct Referral Form | Clover Park Technical College
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Student Conduct Referral Form

Initial Disciplinary Proceedings:  Anyone may file a written complaint alleging that a student has committed a violation of the code of student conduct with the office of the Vice-President for Student Success.  The complaint should state specifically the alleged violation and summarize the supporting evidence.  If the student conduct officer determines the complaint has merit, the student conduct officer shall initiate disciplinary proceedings.


  1. Whenever possible, the instructor or staff member will communicate with the student what specific behaviors have constituted a breach of the code of student conduct.  The instructor or staff member will also tell the student that a referral for student discipline has been made to the student conduct officer and he/she should expect to hear from that office. 
  2. The student will be contacted by the Vice President’s Office to set up a meeting to discuss the allegations.
  3. Please refer to the Clover Park Code of Student Conduct, Chapter 495C-121 WAC for the full text.

Alternate format of this document is available upon request. Please contact Disability Resources for Students Coordinator at or call 253-589-5767.

Fill out if you are CPTC staff or faculty.
Fill out if you are CPTC staff or faculty.
Fill out if you are a student.
Date of Incident