Student Witness Statement
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Student Witness Statement Form WITNESS INFORMATION Student Name: Student Number: Local Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: Campus Email: Classification: Major: INCIDENT INFORMATION Name(s) of student(s) involved: Student 1: Student 2: Student 3: Student 4: Date/time of the alleged incident: Location of alleged incident: WITNESS STATEMENT (Attach additional sheets if necessary) WITNESS CERTIFICATION I certify that this statement provided to the Southern University and A M College Office of the Dean of Students is truthful and accurate..
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