Academic Integrity Violation Report Form

Reporter Information

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Your name:

Your academic department:

Your phone number:

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508-531-XXXX

Your email address:

Email address must be of a valid format.

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xxx@bridgew.edu

Nature of this report(Required):

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Report Date of AI violation(Required):

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Location(Required):

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Course Number and Section:

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ex. ENGL 102-001

Involved Parties

Please identify all individuals involved in this academic integrity violation:

Name

ID Number

Email address

Description/Narrative

Please select the type of academic integrity violation:(Required) This field is required.

Please provide a description of the academic integrity violation in as much detail as possible:(Required) This field is required.

Have you discussed this academic integrity violation with the student? If so, please describe what was discussed: (You may attach documents of emails in the next section)(Required) This field is required.

Please list any sanctions that have been issued as a result of this academic integrity violation, if any:(Required) This field is required.

Supporting Documentation

Other supporting documents may include syllabus AI policy statement, assignment instructions and submitted assignments, and other evidence showing that an academic integrity violation has occurred. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Reporter Information

Involved Parties

Description/Narrative

Supporting Documentation

Submission