INITIAL Academic Integrity Reporting Form

Background Information

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Incident reporter's full name:

Reporter's department/school:

Reporter's phone number:

Reporter's RUTGERS email:

Email address must be of a valid format.

Date of incident(Required):

This field is required.

Unit where incident occurred(Required):

This field is required.

Course Name & Number:

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Example: Calculus I / 01:640:135

Involved Parties

Student's full name

RUID number (XXX00XXXX)

Student's email

Questions

Course instructor's name (if not reporter) This field is required.

Course instructor's department/school (if not reporter) This field is required.

Semester and year of incident(Required) This field is required.

Course Name (ex. "Introduction to Financial Accounting")(Required) This field is required.

Course Number (ex. "33:010:272")(Required) This field is required.

Alleged violation (check all that apply) Descriptions of all violations can be found in the Academic Integrity Policy.(Required)

Plagiarism Cheating Fabrication Facilitation of dishonesty Academic sabotage Violation of research or professional ethics Violations involving potentially criminal activity

You must make at least one selection.

Name of assignment(s) in question (ex. Midterm 1, Quiz 3, Final Exam, etc.)(Required) This field is required.

Percentage of the final grade this assignment(s) is worth?(Required) This field is required.

Description of Incident: Please provide a detailed description of the incident using specific, concise, objective language. If you have listed an individual as an involved person, that person should appear at least once in the narrative. Please provide as much detail as possible about the behavior(s) that prompted the report.(Required) This field is required.

If this matter is found to be a Level 1 or Level 2 case, would you like to adjudicate this matter, or would you like an AIF (if available) to address it?(Required)

I would like to address this incident I would like an AIF to address this incident (if available)

This field is required.

Supporting Documentation

Please attach: 1) the course syllabus; 2) a copy of the assignment/test/quiz in question; 3) instructions for completing the assignment/test/quiz in question; 4) a copy of the Turnitin report (if applicable); 5) any other supporting materials (screenshots, emails, photos, etc.) 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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INITIAL Academic Integrity Reporting Form - New Brunswick

Background Information

Involved Parties

Questions

Supporting Documentation

Submission