Academic Integrity or Professional Program Violations Reporting Form

Instructor Department Head Dean Administrator Student in the classroom Anonymous witness to the alleged violation of academic integrity Complainant Field Supervisor (clinical, rotation, field site) Other:

Cheating Copying or obtaining information from another student’s test paper Plagiarism (the use of other person's work) and such work need not be copyrighted and the unacknowledged incorporation of that work in one's own work offered for credit Using, during a test, materials not authorized by the person giving the test Collaborating, conspiring, or cooperating during a test with any other person by giving or receiving information without authority Stealing, buying, or otherwise obtaining all or part of an unadministered test Selling or giving away all or part of an unadministered test or any information concerning specific questions and items on an unadministered test Requesting, bribing, blackmailing, or in any other way causing any other person to obtain an unadministered test or information about an unadministered test or a test in the process of being administered Substituting for another student, or permitting any other person to substitute for oneself to take a test Submitting as one’s own, in fulfillment of academic requirements, any theme, report, term paper, essay, other written work, art work, painting, drawing, sculpture, musical composition or other art work prepared totally or in part by another person Any selling, giving, or otherwise supplying to another student for use in fulfilling academic requirement any theme, report, term paper, essay, other written work, painting, drawing, sculpture or other art work Submitting artificially produced data or information in the place of descriptive, experimental, or survey results Any other devious means of securing an unearned grade in a non-credit course or in a course offered for credit Student looking on another student’s paper (cheating) The presence on one’s person (or in close proximity thereto) of a condensation of test information - which could be regarded as a “cheat sheet” and will be considered adequate evidence to establish cheating Not applicable in this incident Other (as noted below):

Frequently arriving late to class Continually leaving and re-entering class without permission Loud and distracting noises Talking with others or talking aloud to none in particular Use of cell phones and pagers Eating (e.g. munching on chips, slurping or bringing food to restricted areas) Texting, or using electronic devices for reasons not related to the course Continually interrupting instructor, or other students Grandstanding Sleeping in class Poor personal hygiene Comments that are antagonistic or inappropriately argumentative Comments that are rude or inappropriately critical Comments that are threatening or abusive (In cases of threats of violence or other extreme behaviors, for assistance call UPD at 318.342.5350) Professional Program Behavior Violation (as noted below): Failure to wear appropriate attire (dressing in Professional Program attire appropriate to the agency’s protocol) Professional Program Behavior Violation (as noted below): Failure of punctuality or attendance at field site Professional Program Behavior Violation (as noted below): Failure of establishing and maintaining a regular schedule Professional Program Behavior Violation (as noted below): Failure of following the agency’s (not the University’s) operational schedule Professional Program Behavior Violation (as noted below): Failure of maintaining a current time sheet/log of placement hours Professional Program Behavior Violation (as noted below): Failure of arriving before the appointed time Professional Program Behavior Violation (as noted below): Failure of being prepared to engage as a working professional Professional Program Behavior Violation (as noted below): Failure of providing prompt notification of tardiness or absences Professional Program Behavior Violation (as noted below): Disrespectful demeanor or interactions with staff/clients/peers Professional Program Behavior Violation (as noted below): Failure of conducting oneself in a manner consistent with the values and ethics of the professional program Professional Program Behavior Violation (as noted below): Failure of demonstrating professional oral, electronic or written communication skills Professional Program Behavior Violation (as noted below): Failure of using discretion and appropriate professional language in addressing clients/staff/peers Professional Program Behavior Violation (as noted below): Failure of "filtering" language to limit emotional reactivity/content or outburst Professional Program Behavior Violation (as noted below): Failure of collaborating with one's supervisor to identify and complete a weekly plan/set of work tasks Professional Program Behavior Violation (as noted below): Failure of completing higher priority tasks before secondary tasks Professional Program Behavior Violation (as noted below): Failure of following through on appointed tasks and activities in a professional, high quality and timely manner Professional Program Behavior Violation(as noted below): Failure to be accountable to the agency's practice guidelines and expectations Professional Program Behavior Violation (as noted below): Failure to maintain professional integrity and honesty in activities or interactions Professional Program Behavior Violation (as noted below): Failure to accurate represent placement hours worked and tasks completed Professional Program Behavior Violation (as noted below): Failure to maintain client/agency confidentiality standards (including but not limited to cell phones/electronic devices) Professional Program Behavior Violation (as noted below): Failure to uphold ULM's ethical standards and seeking appropriate consultation when in doubt Professional Program Behavior Violation (as noted below): Failure to maintain strict personal/professional boundaries in the real and virtual work environment Professional Program Behavior Violation (as noted below): Failure to demonstrate a willingness to resolve difficult relationships and modify one's behavior accordingly Professional Program Behavior Violation (as noted below): Failure to demonstrate a non-defensive receptivity to feedback and suggestion Professional Program Behavior Violation (as noted below): Failure to demonstrate a willingness to be self reflective and/or self corrective Professional Program Behavior Violation (as noted below): Failure to demonstrate appropriate effort and initiative Professional Program Behavior Violation (as noted below): Failure to demonstrate accountability and integrity Professional Program Behavior Violation (as noted below): Failure to uphold boundary maintenance Professional Program Behavior Violation (as noted below): Failure to uphold confidentiality Professional Program Behavior Violation (as noted below): Unethical practice Professional Program Behavior Violation (as noted below): Failure of emotional self-regulation Professional Program Behavior Violation (as noted below): Disruptive behavior during field work Not applicable in this incident Other (as noted below)

5.03:11 Sitting, obstructing or placing items such as books, purses, drink containers, etc., in hallways, stairways, walkways, or building entrances or exits. 5.03:12 Documented obstruction, disruption or interference of teaching, research, administration, disciplinary procedures or University-authorized activities or events. 5.03:14 Visitation of other college or university campuses or industrial sites, or any other property (private, public, or corporate) for the purpose of defacing or destroying said institutions or property or of disrupting the normal activities of such said institutions or property. 5.03:15 Abusive, drunken, violent or excessively noisy behavior or expression on University property or at University-authorized activities. 5.03:19 Unauthorized entry or use of facilities or any violation of University rules regarding the use of University property 5.03:20 Discriminatory behavior against any member of the University community. 5.03:22 Lewd, indecent, or obscene/offensive behavior on or off University property. This standard includes similar behavior when utilizing telephones, answering machines, computers, or computer-generated materials and sound systems. 5.03:23 The threat or commission of physical violence and/or against any person on or off University property or at any University-authorized event or other conduct which threatens the health or safety of any person. This standard includes violence purposed to influence an employee's official action, and it includes intimidation and threats made toward the person bringing the charge or witnesses involved in any University disciplinary hearing. This may include cyber stalking. 5.03:25 Disrespect or inappropriate behavior at any time when dealing with students and University personnel, and the general public. This includes various degrees of obscenities and profanities, emails, text messaging and voice mail. 5.03:26 Harassment or bullying (verbal, physical, and/or through social media) or any member or the University community. Stalking or the repeated following or harassing of another person accompanied by the making of a credible threat with intent to place that person in reasonable fear of death or serious injury (including e-mails, text messaging and voice mail). 5.03:27 Failure to comply with University of Louisiana System Board of Supervisors or University rules and regulations related to any areas within their jurisdiction, including but not limited to: library, residence halls, dining services, traffic, automobile usage, conduct on and off campus, conduct in the classroom, organizational activities, and use of building and physical plant. 5.03:34 Violation of University Drug Policy. 5.03:35 Violation of University Alcohol Policy. 5.03:36 Falsification, forgery, alteration or misuse of university documents, records, identification cards or meal tickets - furnishing false information to the university with the intent to deceive. 5.03:41 Giving false testimony or other evidence at any official hearing of the university or giving false information to any faculty or staff member acting in the performance of his/her duties. 5.03:42 Academic Cheating 5.03:42 Plagiarism 5.03:43 Violation of censures imposed by the Office of Student Advocacy and Accountability or any other specified University unit. 5.03:44 The commission of acts or attempted acts on or off University property, at University-authorized events or on any property owned, leased, or occupied by any formal or informal organizations associated with, approved by, or identified with the University, including without limitation, any athletic club, academic club, social club, fraternity, sorority or other society, which acts or attempted acts constitute a violation of federal, state, parish or municipal law. 5.03:45 Giving, taking or acquiring possession of, without permission, any academic (tests, research papers, notes, books, periodicals, or etc.,) or personal information, passwords, confidential documentation, or financial materials from an office, student worker or employee of the University. This would include copyright violations and security access to university systems. 5.03:46 Unauthorized access to or misuse of University computers, computer systems, networks or services. This includes but not limited to social media sites or services such as FaceBook, My Space, Twitter etc. Students using computer resources at the University must have an account issued to them and must abide by the terms and conditions stated on the account authorization form. All admitted students automatically have an account issued upon admission approval and therefore are required to use this University assigned account for computer resources at the University. All students must abide by the terms and conditions stated in the Technology Acceptable Use Policy found at http://ulm.edu/computingcenter/use-policy.html. 5.03:52 Cyberstalking - Use in electronic mail or electronic communication of any words or language threatening to inflict bodily harm to any person or to such person's child, sibling, spouse or dependent, or physical injury to the property of any person, or for the purpose of extorting money or other things of value from any person. Repeated electronic mail or electronic communication to another person, whether or not conversation ensues, for the purpose of threatening, terrifying, bullying, or harassment of any person. Electronic mail or electronic communication to another and to knowingly make any false statement concerning death, injury, illness, disfigurement, indecent conduct or criminal conduct toward the person electronically mailed or of any member of the person's family or household with the intent to threaten, terrify or harass. Knowingly permit an electronic communication device under the person's control to be used for the taking of an action, as noted, in other "Acts of Misconduct," 5.03:45 (giving, taking or acquiring possession of, without permission...), and 5.03:46 (unauthorized access to or misuse of university computers, systems, networks or services...). Use of electronic platforms or online communication for the purpose to demean or harm others and / or to commit a hate crime when, by reason of the actual or perceived race, color, creed, religion, ancestry, gender, sexual orientation, physical or mental disability, or national origin of another individual or group of individuals, regardless of the existence of any motivating factor(s). Other (as noted below): Not applicable

Documentation Email Photo Video Online Source Online Reference Eye Witness Statement Repeated Offenses Not applicable Other (as noted below):

6.01:02 - Reprimand (warning only with no further action) - Reprimand will not become part of a student's permanent disciplinary record in the Office of Student Advocacy and Accountability and students may not appeal this censure - the hearing officer's decision is final. 6.01:10 - Forfeiture of Rights and Privileges - This sanction is an adaptable penalty in that the appropriate University Unit may recommend limitations to fit a particular case. For the purpose of modifying behavior, reasonable forfeiture of privileges may be imposed. 6.01:12 - Assigned a value of zero (0) for the work involved. 6.01:12 - Assigned the grade of "F" for the course. 6.01:12 - Failing Grade -To be assigned to a student for a work in question or as the final grade for a course in which the student is found responsible of academic cheating or plagiarism. 6.01:14 - Suspension from Class - Student found responsible of classroom disruption, falsification of documents, or excessive absences may be suspended from that class either for a specified period of time or for the remainder of the semester. 6.01:15 - Suspension from a School or Degree Program—A student may be suspended from re-entering a specified school or degree program for violations of stated University policy. This suspension is for a specified period of time. 6.01:16 - Permanent Dismissal from a School or Degree Program—Permanent suspension from a school or degree program. 6.01:17 - Suspension from an Academic College—A student may be suspended from a particular College for a specified period of time for violations of stated University policy. 6.01:18 - Permanent Dismissal from an Academic College—Permanent suspension from a college. Other: (as noted below). Not applicable - I am a witness to the incident and submitted this form for reporting purposes only.

Not applicable " Section One - Introduction Section Two - Hearing Panels Section Three - Statement of Rights and Responsibilities Section Four - Procedural Due Process Principles Section Five - Standards of Conducts for Students Section Six - Censures (Disciplinary Censures) Section Eight - Appeal Procedures Section Nine - Student Records (FERPA) Section Ten - Organizational Structure and Due Process * Appealing a ruling on cheating/plagiarism (http://catalog.ulm.edu/content.php?catoid=27&navoid=3206) *Appealing a grade (http://catalog.ulm.edu/content.php?catoid=27&navoid=3202) *Appealing academic suspension (http://catalog.ulm.edu/content.php?catoid=27&navoid=3194&hl=suspension+appeals&returnto=search).

Cheating and Plagiarism Policy Cell Phone Policy Class Attendance Regulations Classroom Behavior Policy Professional Program Behavioral Guidelines Online Attendance Policy I am a witness to the incident and submitted this form for reporting purposes only Other: (as noted below) Not applicable

You are required to schedule an appointment to meet with the instructor You are required to schedule an appointment to meet with the dean/department head/director You are requested to schedule an appointment to meet prior to the next class meeting You may schedule a meeting via email You may schedule a meeting via phone message (leave contact information) You are not required to meet regarding this incident Not applicable in this incident Other (as noted below):

Instructor copied "Cc'd" the student upon submission of this report to Office of Student Advocacy and Accountability Instructor sent the incident report directly to the student's email Instructor mailed a hard copy of the incident report to the physical address noted on Banner Instructor met with the student face-to-face and provided a copy of this report Instructor contacted the student via phone call.