Self Report

Use by School Personnel Only.

What policy or bylaw are affected

Provide a description of the circumstances leading to the reported violation; Provide the name of the student and/or coach (if applicable)

List the contest(s) in which the student participated (if applicable); also indicate if the result of the contest was a "win"

List any corrective actions taken or NONE if applicable.

You acknowledge that all the information on this form is accurate by typing your name here

Your phone for followup information

1 + 5 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.