Sixth College Judicial Affairs Request Form
Note: Please plan accordingly as this request form could take approximately up to 3 - 7 business day turn around before you are notified of its completion.

1) Please complete this form to request a Disciplinary Review of your Student Record and ensure that your information is clearly printed on the Disciplinary Form that you are submitting (i.e. Study Aboard, Dean Certification, etc.) to Sixth College Academic/Student Affairs (i.e. your name, address, and signature of the form(s)).

2) Bring your form(s) to the front desk of Academic/Student Affairs office located on the Second Floor of Pepper Canyon Hall.

3) The Sixth College Academic Affairs and/or Student Affairs staff will fill out the form.

Completed Forms Status:

Study Aboard - Completed forms are directly emailed to Study Aboard Office.

Dean's Certifications/Gov. Agency/Transfer Reports, et al: - Completed forms are placed in a sealed UCSD envelope and stamped "Confidential". You will receive either a email and/or phone call to come to the Second Floor of Pepper Canyon Hall for pick up.

If you have questions, please contact the Sixth College Assistant to the Dean, Jo-Ann Marie Hoye at 858.822.5953 or

Student Information
Name: *
Your answer
PID: *
Your answer
UCSD Email: *
Your answer
Phone/Cell: *
Your answer
Disciplinary Review Request Form
Please select the type of forms that you are requesting to be completed.
Form Types *
Form Completed Notification:
Please select method you wish be notified when the form is ready for pickup

Note: This is ONLY specific to the Dean's Certification, Gov. Agency, Transfer Reports and/or Other

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