ࡱ> ] hbjbjzqzq 4&/\/\B %8<3c*@@@@///bbbbbbb$fhRb/////b@@bmmm/R@@bm/bmmV[@̥RX6bc03cX i il[[ i^b@//m/////bbm///3c//// i/////////> L:    HYPERLINK \l "_top" Initial Student Misconduct Report: Faculty-led Study-Abroad Course  (Termination from a program may involve an infraction serious enough for the student to be dismissed without warning.)Student Name: Date of Incident: 91̳ ID:Course/Program: Faculty in Charge:Country: Infraction: The students misconduct/behavior has a negative effect on his/her own: Physical health Mental Health Personal Safety Education/Cultural Experience Legal jeopardy Conduct status at LU Others: Explain: ____________________________________________________________________________________ The students misconduct/behavior has a negative effect or might endanger other participants Physical health Mental Health Personal Safety Education/Cultural Experience Legal jeopardy Conduct status at LU And/or might bring the program into disrepute/ jeopardy Explain: ____________________________________________________________________________________ I ______________________________________________ (print name) hereby understand the nature of my infraction and recognize that if the situation persists, that steps will be taken to have me dismissed from the study abroad course and that I will not earn credit or be refunded any expenses that have been paid. Also, I will reimburse the grant money to the Global Studies and Study Abroad, and I will be sent home immediately at my own expense. Student Signature: ________________________________________ Date: ___________________ Faculty signature: ________________________________________ Date:____________________ Witness name(print): ______________________________________ Witness Signature: ________________________________________ Date: ____________________ Provide, via e-mail, a digital copy to the Office of Global Studies and Study Abroad     Form rev. 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