SIUE

Smoke Free Campus

Smoke-Free Campus Non-Compliance Form

This form allows a report to be made regarding a specific person not in compliance with the Smoke-Free Campus initiative or regarding a campus location where smoking is occurring.

Contact Information for person reporting policy violation*:

Name
Email

Violator's Information*
Please list information on the person in violation of the Smoke-Free Campus policy.

How many people were in violation of the policy?
Name of person(s) violating the policy:
What is the classification of the person(s) violating the policy?
If faculty or staff, what department do they work in?
Where did the violation occur?
What date did the violation take place?
What time did the violation occur?
How many days or times has the violation been observed?

Current Students
Faculty & Staff
Alumni
Community & Business Partners
Veterans