School of Education Civil Infraction Form

The Michigan Department of Education requires all colleges/universities to request information from all potential and current teacher education candidates regarding civil infractions, convictions, substantiated cases of child abuse or neglect. You must answer the following questions truthfully. Falsification of any information regarding your criminal history may be grounds for dismissal from the School of Education at Spring Arbor University and/or denial and/or revocation of your teaching certificate from the Michigan Department of Education. If you have had a case of child abuse or neglect substantiated against you and/or if you are required to register with the Child Abuse/Neglect Central Registry, you may be unable to complete the requirements for the Early Childhood Education major or minor. As of January 1, 2006, all questions enumerated below pertain to both juvenile and adult convictions. (If you are unsure of whether you have a conviction on record, you must contact the court in the county where the incident in question occurred.)

Have you ever accepted responsibility in a civil infraction (excluding speeding tickets)?*

Yes
No

Have you been convicted of a misdemeanor in any state, jurisdiction, or country?*

Yes
No

Have you been convicted of a felony in any state, jurisdiction, or country?*

Yes
No

Have you ever been required to register under the Michigan Sex Offenders Registration Act?*

Yes
No

Do you have any misdemeanor and/or felony charges pending against you in any state, jurisdiction, or country – including any charges against you in the military?*

Yes
No

Have you ever had a case of child abuse or child neglect substantiated against you?*

(Substantiated means an investigation was conducted and child abuse and/or neglect was found to be substantial)

Yes
No

Have you ever been required to register with the Child Abuse/Neglect Registry?*

Yes
No

Have you already met with School of Education personnel regarding all the convictions that pertain to you, including those that are pending?*

Yes
No

*For Your Information: Pleading “No Contest” is still considered by the Michigan Department of Education to have been convicted of the crime and you must answer, “yes” to the appropriate question(s) above.

IMPORTANT NOTE If you have answered, “yes” to any questions above, you will be contacted to set up a formal meeting with School of Education representatives to receive information and sign a form acknowledging your understanding of your possible risk for obtaining certification. You must also complete the “Conviction Questionnaire” for each conviction against you. This questionnaire will be made available to you at the meeting with the SOE representatives. You must have one completed/signed “Conviction Questionnaire” on file in the School of Education office for each misdemeanor or felony. You must report any future convictions or substantiated cases of child abuse or neglect to the School of Education in a timely manner during your enrollment in the Spring Arbor University School of Education program in order to remain a student in good standing.

Name*

First Last

Student ID Number*

Would you like to digitally sign or type your signature?*

Digitally Sign
Type

Type Your Name*

By typing your name you verify all of the information above is correct to the best of your knowledge.

Signature*

By signing your name you verify all of the information above is correct to the best of your knowledge.

Phone

This field is for validation purposes and should be left unchanged.