Academic Dishonesty Report

Background Information

Your full name:

Your email address:

Email address must be of a valid format.

Alleged violation(Required):

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If reporting more than one violation, please specify in the narrative text box below

Date of incident(Required):

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Time of incident:

Location of incident(Required):

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(required)

Specific location:

Involved Parties

Student Name

CTC Link ID Number

Questions

Please complete the questions below. If you do not have access to the information requested, please indicate that in the answer box.

Please provide the following information: Course Number, Course Name, and Quarter Enrolled(required)(Required) This field is required.

Please indicate the type of course (required)(Required) This field is required.

Please provide a detailed description of the incident using specific, concise, objective language. (Who, what, where, when, how it happened.) Additionally, provide any additional information in this section that you believe is pertinent to this incident. (required)(Required) This field is required.

What, if any, academic consequences have been issued as a result of this alleged academic violation? Please note: An instructor retains authority over any academic grade issued within a course. (required)(Required) This field is required.

Instructors are expected to make a reasonable effort to discuss the allegations with the accused student prior to referral to the Office of Student Conduct. In addition, it is recommended to inform the student that you will submit a report to the Office of Student Conduct of the incident. Have you addressed this issue with the student(s) involved? (required)(Required)

Yes No

This field is required.

If YES, please indicate the date and time of the discussion as well as provide a description of the conversation and outcome. What did you do or say to the student in response to the situation or behaviors? What was the student's response?(This is very important - please provide detailed information). This field is required.

If NO, please select one of the following: This field is required.

What outcomes would you ideally like to see? (We take your feedback into consideration in fact-finding and assessment processes)(Required) This field is required.

Upon receiving this report, the Student Conduct Manager will schedule a meeting with the student to discuss the matter. If you prefer this not to occur, please indicate it here. We understand some faculty submit reports for documentation purposes. Also note: if this is the second documented report of academic dishonesty, the Student Conduct Manager is required to meet with the student. This field is required.

Supporting Documentation

When submitting this form, you are required to include any applicable documents: * Course Syllabus * Assignment Instructions/Directions (if applicable) * Student’s quiz, test, exam, sanction, Student’s entire paper * Any relevant information describing the plagiarism (text messages, pictures, video, any forged documents) * Other supporting documents (i.e. email messages (conversation threads between you and the student, student to student). 1GB maximum total size. Attachments require time to upload, so please be patient after submitting this form. 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