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Index Code: CRIH
Criminal History/Disciplinary Action Form
Name: Date:
CSU ID Number: Email:
According to the information you provided on your application for admission, you indicated one
of the following:
You have been convicted of a criminal offense or pending criminal charges; Or,
You have been suspended or expelled from a secondary or post-secondary educational
institution for disciplinary reasons.
Please provide a detailed explanation of the event(s) that occurred below. Additional
documentation may be requested as needed.
Please return this form to:
Office of Admissions
Columbus State University
4225 University Avenue
Columbus, GA 31907