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Dean of Students Form
Dean of Students form
Your Name:
Title:
Institution:
Phone Number:
Email:
Student's First Name:
Student's Middle Name:
Student's Last Name:
Student's Birthdate:
1. Has the student been enrolled at your institution at any time?
Yes
No
2. Is the student eligible to re-enroll at your institution?
Yes
No
3. Has the student received any official disciplinary action from your institution?
Yes
No
4. To the best of your knowledge, has the student been arrested, charged, or convicted of a criminal offense?
Yes
No
5. To the best of your knowledge, has the student exhibited behavior that could be perceived as threatening?
Yes
No
6. If not stated above, is there any reason why the student should not be admitted?
Yes
No
Note: If you answered yes to any of the questions 3-6 above, please explain.