Code of Conduct Form for Student Behavior and Academic Integrity

Background Information

Please provide us with the following information:

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Type of Incident(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please provide as much information about all of the people involved as possible.

Name or Organization

Gender

Role of Person in Incident

Student ID Number (8 digit number)

Questions

Description of Incident(s): Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how). Please be professional, accurate and factual.(Required) This field is required.

Has the student been notified that an incident report is being filed?(Required)

Yes No

You must make at least one selection.

If applicable, suggest or identify a possible resolution(s) you would like to see through the student conduct process (outcomes, informational only, etc): This field is required.

Faculty Only: If there is an alleged academic integrity violation, have you taken any action in your course in response to the concern to date? (Please indicate yes or no, and describe any action or consequences you have assigned per your classroom policies.) This field is required.

Supporting Documentation

Please attach any supporting documentation that you feel we should have while hearing the case (video, documents, pictures, etc...) 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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Background Information

Involved Parties

Questions

Supporting Documentation

Submission