Tribunal Referral Form
Person Making Petition (First Name Last Name) *
Your answer
Date of Offense *
MM
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DD
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Student(s) involved *
Your answer
Grade Level of Students Involved *
Your answer
Category and Nature of Incident *
Mark all Character Counts Pillars that the student(s) violated
Required
Please explain how the previously selected Character Counts Pillars were violated and how GECA's Honor Code was violated *
Your answer
Date and Time Available for Attorney General – Cristy Aguilar – to meet with you *
Option 1
MM
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DD
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YYYY
Time
:
Date and Time Available for Attorney General – Cristy Aguilar – to meet with you
Option 2
MM
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DD
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YYYY
Time
:
Date and Time Available for Attorney General – Cristy Aguilar – to meet with you
Option 3
MM
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DD
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YYYY
Time
:
If possible, would you like this matter “mediated” with the Attorney General? *
Any additional comments you would like to make?
Your answer
E-Signature of Petitioning Individual (Staff member, Student, etc.) *
Type in full initials
Your answer
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