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Academic Misconduct Report Form

Please use this form for academic misconduct violations. If you would like to report a Student Code of Conduct issue or make a BIT referral, please click here

Instructor Information

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Your 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:

Department(Required):

This field is required.

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Please select a department...

Course Number/Section:

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Ex: HIS 20100 00

Involved Student(s)

Involved party 1

Student Name

Role

Student ID#

Questions

Please provide a detailed description of the incident(Required) This field is required.

Did you discuss this with the student?(Required)

Yes No I tried but the student did not respond

This field is required.

What form(s) of discipline was imposed for this incident of academic misconduct? Choose all that apply.(Required)

E in course

E on test/exam

E on assignment

Plagiarism Traffic School

Redo the assignment

Other

You must make at least one selection.

You may be called upon to participate in the appeal process. When would you be available?(Required) This field is required.

By submitting this form, I am aware that if this is a second cheating /plagiarism offense that results in failure of a class, the student will be dismissed from the college for the remainder of the semester in which the second violation occurs and the following academic semester that is required for that student's program of study.(Required)

Yes

This field is required.

Supporting Documentation

When submitting this form you are required to include:
A copy of the syllabus
Any relevant information (tests, papers, etc.)
Other supporting documents (if submitting emails please copy into a word document)

If you are unable to submit copies electronically, please forward these copies to the dean/director within 2 working days of submitting this form. 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