BIT, Conduct, Academic Misconduct Referral Form

Background Information

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(Required):

This field is required.

Urgency of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please list the individuals involved (excluding yourself), complete as many of the boxes as you can. For non-students, please list a SSN or Drivers License number in the block labeled SID if available. OR skip to the description box below and complete in detail. WHEN ENTERING THE STUDENT ID LEAVE the "S" OFF.

Name or Organization

Select Gender

Select Role

Student ID

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

ACADEMIC

Cheating by Copying

Dishonest Collaboration

Fabrication

Other acts of academic dishonesty

Plagiarism

You must make at least one selection.

B.I.T. (BEHAVIORAL INTERVENTION TEAM) REFER CONCERNS ABOUT EMOTIONAL, MENTAL, OR PHYSICAL WELL-BEING

Behavioral Intervention Concern.

You must make at least one selection.

TITLE IX (SEXUAL OR DOMESTIC VIOLENCE) CONCERN

Title IX Sexual or Domestic Misconduct

Title IX: Support for Sexual or Domestic Violence Concern

You must make at least one selection.

Your description of the incident is important so please give as much information as possible. Please use specific concise, objective language. This field is required.

Quick Tip if you are reporting Academic Misconduct: Tip #1: Have you shared the allegation with the student? Tip #2 Have you informed the student they are allowed the opportunity to respond and have the right to appeal? This field is required.

Faculty reporting Academic Misconduct: If necessary; how would you prefer to be contacted? Fill in the blank if different from above: If you are not reporting academic misconduct, please select N/A for the required fields.(Required) This field is required.

Academic Misconduct: What act of academic misconduct did the student allegedly commit? If you select other, please share details in the narrative.(Required) This field is required.

Academic Misconduct: What penalty did you assign the student?(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 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

Questions

Supporting Documentation

Submission