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Academic Integrity Violation Reporting Form

Please complete this form for all cases of academic integrity violations.

Background Information

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Faculty 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.

Date of incident(Required):

This field is required.

Time of incident:

Involved Parties

Please list the individual(s) involved and include the student ID number.

Involved party 1

Name

ID Number

Questions

Course Number(Required) This field is required.

Description of incident.(Required) This field is required.

Did you meet with the student(s) regarding this incident?(Required)

Yes No

This field is required.

Is this the first incident of academic dishonesty with this student in this class?(Required)

Yes No

This field is required.

Please indicate the action you have taken(Required)

"F" in the course

Lower grade in the course

"F" on the assignment/paper/exam

Lower grade on the assignment/paper/exam

Re-do the assignment/paper

Warning

You must make at least one selection.

Are you submitting this student for tracking only or for discipline action?(Required)

Tracking Only Discipline Action

This field is required.

Supporting Documentation

Please include a course syllabus, work in question, and any supporting documentation/evidence. You can upload the documents here or send them via inter-campus mail to the Judicial Affairs Office, MSR 360. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission

Email me a copy of this report