Honor System Academic Misconduct Referral Form

Referring Party

In order for the Honor System to process the case, you must include at least, the name, title, and email of the referring party.

Enable additional features by logging in.

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Campus Box:

Nature of Report(Required):

This field is required.

Affiliation(Required):

This field is required.

Learn more

What is your affiliation to the University as a referral source?

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please enter as much information as possible about the parties involved. Your information is captured above and does not need to be added to this section.

Name or Organization

Select Gender

Select Role

PID Number

Email address

Course and Incident Information

Please select the department for which the course is located(Required) This field is required.

School/College(Required) This field is required.

Please enter the course name and course ID. example (EUXX 104-01)(Required) This field is required.

Please provide a narrative of the incident. If you wish to attach a written narrative, please enter "see attached" in the space below and upload the narrative as instructed in the next section.(Required) This field is required.

Have you met with the student?(Required) This field is required.

I am interested in making a sanctioning recommendation.(Required)

Yes No

This field is required.

Student Conduct will ask you for the final grade after the case is resolved, which may be several months from the date of this submission. In situations where the student is not charged or found not responsible, you will need to calculate a final grade based on their academic performance, accordingly. If they are found responsible, your recommended grade sanction will be considered either as the final grade in the course, or in the calculation of their final grade. Select one of the following statement:(Required)

A. The grading period isn’t over, and I will continue to grade the student’s assignments in preparation for Student Conduct’s request for their final grade B. The grading period has passed, and I have a record of their graded assignments. I will be able to calculate the final grade with or without the recommended grade sanction and inform Student Conduct once the outcome is final C. I don’t have the ability to calculate the student’s final grade

This field is required.

Do you have any scheduling conflicts in the next several months (ex: sabbatical, visiting professor, research commitments, etc.) that might interfere with you being available to fully participate in the Honor System process?(Required) This field is required.

I have attached the syllabus for the course in question, if applicable:(Required)

Yes No

This field is required.

Supporting Documentation

Please attach any additional materials you would like to submit as part of this referral. Please format your attachment(s) as a PDF. Helpful document(s) may include course syllabus, relevant email correspondence, copies of exam(s) or assignment(s) in question - annotated if possible, exam(s) or assignment(s) instructions, or signed honor pledge. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Referring Party

Involved Parties

Course and Incident Information

Supporting Documentation

Submission