Student Conduct Hearing Panel Application

*Upon completing the application form, please print and submit your application to the Office of Judicial Programs, located on the 3rd floor of the Speare Administration Building.

Student Conduct Hearing Panel Application

Basic Information

 

First Name:

Last Name:

Local Address (Street/City/State/Zip):

PSU Email Address:

Cell Phone Number:

(Students Only) Student ID#:

Major/Cumulative G.P.A.:

 

Written Response Questions (Please attach responses to application)

 

1. Why are you interested in serving on the University hearing Panel?

2. What do you feel is the role of the University Hearing Panel?

3. Please list any extra-curricular activities in which you have participated, including any

leadership positions that you have held or currently hold.

4. Have you ever received a disciplinary sanction at PSU? If so, describe you learned from the experience.

5. What additional time commitments do you have? Please share your schedule.

 

References

 

REFERENCE #1 – Name (First and Last):

 

Title:

 

Relationship to You:

 

Email Address:

 

Phone Number:

 

REFERENCE #2 – Name (First and Last)

 

Title:

 

Relationship to You:

 

Email Address:

 

Phone Number:

 

HEARING PANEL CONFIDENTIALITY AGREEMENT

As a member of the Hearing Panel, I understand that confidential information regarding students will appear in the course of my Hearing Panel activities. This confidential information may include transcripts, personal files, conduct activities, medical and psychological information, and other written materials of a sensitive nature. The Family Educational Rights and Privacy Act (FERPA) protects the privacy of student records.

 

I understand that confidential information is never to be removed from hearing documentation or discussed with anyone outside the hearing itself. I agree to follow this policy at all times. I further understand that any breach of this agreement will result in conduct action and/or immediate dismissal from the Hearing Panel.

 

In the event that someone calls or approaches me requesting information about potentially confidential information, I should explain to the person that I am unable to help them with that information and refer them to the Coordinator of Student Conduct and Community Standards.

 

 

Print Full Name ____________________

Signature   ________________

Date______________

 

 

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