Assertion of Lack of Capacity and Acknowledgement of Suspension from the University

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Student's First Name:

Student's Last Name:

Student's Computing ID:

Student's Email Address:

Committee Case Number:

Date of Hearing/Trial (if scheduled)

Understanding Procedures

I have read and I understand the Procedures for Honor Cases and Student Disciplinary Cases Involving Contributory Health Impairments (the “Procedures”), and I hereby assert that I suffer from a Lack of Capacity (as defined in the Procedures) to stand for an Honor hearing or a University Judiciary trial at this time.

Acknowledgement Regarding Immediate Suspension

I understand and acknowledge that, by reason of my assertion of a Lack of Capacity to stand trial, I am subject to immediate suspension from the University pursuant to the Procedures, and that I will not be re-admitted to the University unless and until I return to participate in a hearing or trial for the offense(s) with which I have been charged.

Student's Electronic Signature:

Date Signed:

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Understanding Procedures

Acknowledgement Regarding Immediate Suspension