Preview Criminal History Disciplinary Action Form

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

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