Academic Dishonesty Reporting Form

Instructor Information

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Your full name:

Your position/title:

Your phone number:

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Please provide a telephone number where you can be reached if more information is required.

Your email address:

Email address must be of a valid format.

Your academic department:

Date of incident(Required):

This field is required.

Course Number and Section:

Involved Parties

Please enter the names and identifying information all individuals involved, including witnesses.

Name (First Last)

Select Role

PUID (Include all digits including both leading 00s)

Email address

Relevant Information:

Please answer all of the following questions with as much information as possible.

Have you already met with the student?(Required)

Yes Not yet, but a meeting is scheduled No

This field is required.

What determination have you made regarding the student's grade for the assignment/course?(Required) This field is required.

Do you wish to be notified of the outcome of the OSRR conduct conference?(Required)

Yes No

This field is required.

Please provide a detailed description of the incident: (and please upload below supporting documents, including your syllabus)(Required) This field is required.

In your opinion, what response would you like to see from OSRR on this matter? Please note that several factors are considered by OSRR when making a university sanctioning decision, including the severity of the incident, a student's previous disciplinary history, and any mitigating and aggravating circumstances involved in the incident. This field is required.

Supporting Documentation

Please upload all supporting materials regarding the situation, including: a copy of your course syllabus; copies of the exam, paper or other class document in question; relevant email correspondence; witness statements; and any other materials that support the allegation. If your submission does not process correctly, you may need to attach these documents again before re-submitting. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Instructor Information

Involved Parties

Relevant Information:

Supporting Documentation

Submission