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Academic Integrity Violation Incident Report Form


This form is only to be used for submitting academic misconduct (academic integrity violations) incidents to the Office of Student Affairs.

To file an incident report with Student Affairs for student conduct, public health violations, or other issues (not CARE Team), please CLICK HERE.

To file an incident report with the Title IX Coordinator or Deputy Title IX Coordinator for EO Plan Related Concerns (Discrimination or Discriminatory Harassment, Sexual Violence, or Retaliation, please CLICK HERE.

To file a report with the CARE Team, please CLICK HERE.

To file a report with the Bias Incident Response Team, please CLICK HERE.

This report will be routed to the Office of Student Affairs for review. If you have questions regarding a report please contact the Office of Student Affairs at (978) 665-3130 or judicial@fitchburgstate.edu.

Background Information

 
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Involved Parties

Please list the individuals involved including any witnesses (excluding yourself). Complete as many of the listed fields as you can provide. Please provide the student ID number whenever possible.

Involved party 1

Questions

Please complete the following questions:

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Has the department chair been notified of the alleged violation? You will have the option below to carbon copy the department chair on this report.(Required)
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Has the instructor formally notified the student of the alleged violation by letter and/or form? If so, please upload a copy of the letter to this report. Draft letters and/or forms are available on the academic integrity section of the Student Conduct Website (www.fitchburgstate.edu/judicial)(Required)
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Does the student agree or accept responsibility for the allegation of committing academic misconduct?(Required)
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Does the student agree with or accept the academic resolution of this matter as proposed by the instructor?(Required)
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Would you like assistance from Student Conduct in notifying the student of the alleged violation?(Required)
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Supporting Documentation

Please upload a copy of the letter any other relevant materials to this matter. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Select copy recipients

You may have the Maxient Conduct Administrator system provide an electronic copy of this incident report to your department chair by selecting his or her name from this list.
You may have the Maxient Conduct Administrator system provide an electronic copy of this incident report to your department chair by selecting his or her name from this list.

Submission