Academic Integrity Reporting Form

Background Information

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

(You do not need to list yourself as you reported this above.)

Name

ID Number

Incident Information

Course # and Name(Required) This field is required.

Section #(Required) This field is required.

Please input a detailed description of how you became aware of the Academic Dishonesty incident, with as much detail as possible.(Required) This field is required.

Please copy and paste the instructions for the assignments in your syllabus, D2L, or the assignment itself. You can also upload a copy of that document at the end of this report instead.(Required) This field is required.

Did you make a grade change based on this incident?(Required)

Yes on the specific assignment Yes for their overall grade in my course No Other (please explain below)

You must make at least one selection.

Please indicate what you decided and your rationale for the previous question.(Required) This field is required.

Please list your supervising Chair or Dean.(Required) This field is required.

Supporting Documentation

Please attach scanned copies of all concerning documents such as plagiarized papers, unauthorized exam notes, subsequent texts or emails, etc. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Incident Information

Supporting Documentation

Submission