Document No.

: FM-PD-01-02
INFRACTION FORM
Effective Date: Feb 11, 2019

Date: _________________________
To: _____________________________________________ Program/ Yr: __________________
(Name of Student) Student #: ____________________
You are hereby advised to report to the Office of the Prefect of Discipline (OPD) immediately, in connection with the following
infraction/s of Mapúa University Student Rules and Regulations you have committed, as checked hereunder:
 Not complying with the policy on wearing of proper ID
 Disrespect for national symbols
 Violation of parking regulations
 Unauthorized use of network account
 Loitering in corridors during class sessions
 Improper use of lavatories and washrooms
 Misuse of school property
 Making excessive noise
 Spitting or littering
 Vandalism
 Misbehavior during school programs, activities, or competitions
 Disrupting or disturbing classes or making excessive noise within the premises of the university
 Disruptive use of mobile phones, pagers, or other similar communication devices during classes
 Use of mobile phones, pagers, or other similar communication devices during an examination
 Eating and/or drinking inside the classrooms, laboratories, or other designated places within the university where
eating and/or drinking is prohibited
 Wearing inappropriate campus attire: shorts/skirt more than 2” above the knee; torn pants; pants with
unstitched/untrimmed edges; sleeveless/bare-midriff or spaghetti straps; slippers
 OTHERS (as specified) ____________________________________________________________
Failure to comply will merit a more drastic disciplinary action.
_____________________________________
(Instructor / School Official / Security Officer)

I hereby acknowledge receipt (not necessarily an admission of guilt) of this report of alleged infraction of school regulations
and I promise to see the Office of the Prefect of Discipline immediately regarding this matter. I also agree that all personal
information contained in this form, or that collected, used or processed shall be used solely for legimate purposes,
particularly in the investigation and/or resolution of my alleged infraction/disciplinary case, and which information shall only
be processed by authorized personnel in accordance with the Data Privacy Policies of the University.

_____________________________________
(Signature of Student)

Received:
To be accomplished in triplicate:
Blue Copy: OPD
Green Copy: Student ___________________________________
Pink Copy: for: Office of the Prefect of Discipline

FM-PD-01-02