Student Disciplinary Form

Student Code of Conduct Violation - Written Warning

Please read before completing this form

This form creates an official written warning letter. It is not for internal notes or informal documentation.
This step should only be completed after an incident has been created and fully completed in the GXG Portal.
A written warning letter may only be issued with the express approval of a Program Director or Program Manager, unless you are a Program Director or Program Manager yourself.
Submitting this form begins a formal office process and will lead to communication with parents or guardians. The completed letter will be sent to the student and the office, and shared with parents or guardians as written.
Please write clearly, professionally, and objectively. Pay close attention to tone, grammar, spelling, and sentence structure, as this letter reflects on both you and ActionQuest.

Please review all entries carefully before submitting.

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Student Code of Conduct Violation - Written Warning

Student Full Name*

Staff Full Name*

Program / Trip / Vessel*

Infraction Location*

Infraction Date*

Code Infraction Type*

Other Violation Description*

Warning Type/Stage*

Factual Description of Code Infraction*

Briefly describe what occurred using factual, objective language only. This paragraph will be displayed in the written warning letter.

Please provide details of the previous warning(s).

List the date(s) and a brief summary of the prior verbal warning(s). This information must be consistent with the Incident report. Use the "+" button to add rows.

Previous Infraction Information*

Approx. Date

Brief Description

Behavioral Changes Required*

Clearly state what the student must do differently moving forward. List up to 5 specific behavioral expectations. Use the "+" button to add rows.

Staff Support*

Please describe up to 3 specific ways staff will support the student in meeting these expectations. Use the "+" button to add rows.

Student Code of Conduct Violation - Written Warning

Student Name: {student_name:2}
Staff Name: {staff_name:3}
Program: {program:5} - {location:7}

This letter serves as formal documentation of a behavioral concern that has been discussed with you during your ActionQuest program. ActionQuest expects all students to contribute to a safe, respectful, and cooperative group environment. Your recent conduct did not meet those expectations.

The behavior documented here relates to the following code violation category: {violation_type:54:value}{other_violation_description:32}

On or about {infraction_date:6}, the following concern was observed and discussed with you:

{infraction_details:11}

This written warning is being issued following prior verbal discussion(s) and warning(s) regarding this behavior.

{prior_warning_information:16}

Due to the seriousness of this matter, this issue is being documented in writing immediately rather than beginning with a verbal warning.

In order to remain in good standing, the following behavioral change(s) are required immediately:

{required_changes:19}

ActionQuest staff are committed to supporting you in making these changes. The support or guidance being offered includes:

{staff_support:20}

This letter serves as a formal written warning regarding this behavior. We expect immediate and sustained improvement. Any continuation of this behavior, or failure to meet the expectations outlined above, may result in further disciplinary action, up to and including dismissal from the program without refund.

By signing below, you acknowledge that this letter has been reviewed with you, that you understand the expectations described above, and that you have had the opportunity to ask questions or provide comments. Your signature confirms receipt and review of this letter and does not necessarily indicate agreement with every detail.

Student Affirmation

Student Affirmation of Understanding*

I have reviewed this letter with a staff member and understand the behavior expectations described above.

Student Signature*

Date*

Student Email Address

For copy of the written warning letter

Staff Affirmation

Staff Signature*

Date*

Staff Email Address

For copy of the written warning letter

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Prior Warning Text for PDF

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No Prior Warning Text for PDF