Community Service : Dean of Students Office : Texas State University

Are you a Texas State student? *

Yes

No

Name (First and Last) *

Local/Cell Phone # (Ex. 512-245-3601) *

E-Mail *

Classification *

Freshman

Sophomore

Junior

Senior

Other

If "other," please indicate.

Student ID# (Ex: A0...) *

Date of Birth (mm-dd-yy) *

Major *

Do you have transportation? *

Yes

No

Are you involved in any student organization? *

Yes

No

Charge/Violation *

Have you ever had any previous tickets/arrests? *

Yes

No

If yes, please state previous charge(s).

If referred by a judge/attorney/probation officer, please give their name below:

If referred by a judge/attorney/probation officer, please give their address below:

If referred by the Dean of Students Office, please select the correct staff member you have met with:

Ismael Amaya, Assistant Dean

Santiago Jay Arellano, Conduct Officer

If referred by Housing and Residential Life, please give the residence hall name or Hall Director below:

If referred by another source, please provide the information below:

Total hours needed *

Due Date (mm-dd-yy) *

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

Community Service