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Student Information Request Form


If you would like to schedule an appointment to review a copy of any student conduct record(s) that you were involved in, please complete this form. Please note that reports will only be released once the incident has completed adjudication by the appropriate campus office. The report will be redacted and will only contain information pertinent to your role in the incident(s).

Reports will be available for review at the Office of Student Rights and Responsibilities located in Siemens Hall, Room 211. A representative of the office will contact you when the report is ready and to schedule an appointment. Appropriate processing and printing fees may apply. You will need to present proper identification and arrange for payment in order to receive this documentation.


For further information, please refer to our website.

STUDENT INFORMATION

**Please ensure you include your information below

Email address must be of a valid format.
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If you are unsure of the exact date or requesting your complete conduct record, leave this blank.

Involved Parties

Involved party 1

Questions

The following section should only be completed if student conduct records or a conduct check needs to be realeased to a 3rd party

 

In order for us to realease information to a 3rd party other than the student, we are required to have a "Consent for Release of Information", which you can access HERE. Please upload this consent to this form or email to osrr@humboldt.edu. If you have any questions, feel free to email osrr@humboldt.edu

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UPLOAD RELEASE OF INFORMATION HERE (for 3rd party releases only)

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission