Conduct Record Request Form

Requestor's Information

Enable additional features by logging in.

Your Full Name::

Phone Number:

Email Address::

Email address must be of a valid format.

Organization or Student's Information

If you request this informaiton on behalf of a student of multiple students, you may attach an Excel roster to this form. The Excel document should include the names and full student identification numbers for each student.

Name or Organization

ID Number (if applicable)

Student or Organization Representative's Phone number

Student or Organization Representative's Email address

Information Request

There are two types of requests including, a letter from the Office of Student Conduct and Community Standards reporting any disciplinary history and a form that you attach requesting information related to your disciplinary history. For any other disciplinary requests other than the foregoing, please email the Office of Student Conduct and Community Standards at studentconduct@nccu.edu.

Request type:(Required)

Letter from the Office of Student Conduct and Community Standards Attached Form (i.e. Dean's Certification Form)

This field is required.

Please indicate the third party individual(s) and/or entities to whom this information is to be released. Include Name (first, last), email address and organization/office. Failure to provide complete information will result in a delay of processing.(Required) This field is required.

Please indicate the purpose of the disclosure.

Protection of Minors Regulation Requirement Employment Transfer Admission Graduate or Professional School Admission Other

You must make at least one selection.

If you selected "other," indicate your purpose below.(Required) This field is required.

I understand that my consent is required by the Family Education Rights and Privacy Act of 1974 (“FERPA”). I understand that I have the right to: (1) not consent to the release of my conduct record(s), (2) inspect any written records released pursuant to this consent, and (3) revoke this consent at any time by delivering a written revocation to the Office of Student Conduct and Community Standards. By selecting "I Agree" and submitting this form, I acknowledge the above statements and I give my permission to the Office of Student Conduct and Community Standards at North Carolina Central University to release the above identified information.(Required)

I Agree

You must make at least one selection.

Attached Form

If you have a form to attach, please do so here. 1GB maximum total size. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Requestor's Information

Organization or Student's Information

Information Request

Attached Form

Submission