Academic Integrity Report

Background Information of Reporter

Enter your contact information below:

First and Last Name:

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Full first and last name

On-Campus Extension:

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5 digit phone extension (7-XXXX)

Email Address:

Email address must be of a valid format.

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Montgomery College email address

Office # (Example: MT 605):

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Building and room number

Date of Incident(Required):

This field is required.

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When did the issue take place?

Time of Incident:

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Choose the closest time in 15 minute incriments

Location of Incident(Required):

This field is required.

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On which campus did the incident take place? If online, choose your home campus.

Building & Room # of Incident:

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(Example: SA 133A)

Involved Student(s)

Complete the section below. If there is more than one student involved with the same act of academic dishonesty, click on "Add another party" to include those students in the same report.

First and Last Name

Student's M# (use a capital M)

Incident Information

Complete the sections below:

Please describe the academic violation. Be as specific as possible.(Required) This field is required.

Please choose the sanction the student has received:(Required)

A grade of F on the assignment or test A grade of F for the course A referral to the Dean of Student Affairs for other sanctions

You must make at least one selection.

Have you contacted the student in writing? If you answer "NO" to this question, STOP and contact the student immediately. Per the Student Code of Conduct, the faculty member must contact the student in writing before submitting to the Dean of Student Affairs. Once you have notified the student please continue with the submission of this form. For a generic, fillable PDF template click here: Faculty Letter to Student Template (PDF) (My MC Authentication Required)(Required)

Yes. Please submit a copy of the correspondence sent to the student below in Supporting Documentation. No.

You must make at least one selection.

What is the course and the CRN of the course in which the incident occurred? (e.g., SOCY 100 and 23571)(Required) This field is required.

By submitting this report you agree that the information is accurate and you understand that the report cannot be rescinded.(Required)

Yes

This field is required.

Supporting Documentation

In order to process this incident, you must submit the following:
1) A copy of the correspondence sent to the student
-- Use the Faculty Letter to Student Template (PDF) (My MC Authentication Required)
2) A copy of the student's work
3) A copy of your syllabus

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 of Reporter

Involved Student(s)

Incident Information

Supporting Documentation

Submission