Academic Integrity Reporting Form

Background Information

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Faculty Name:

Phone number:

Email address:

Email address must be of a valid format.

Nature of Violation(Required):

This field is required.

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Please indicate the severity of the allegation

Type of Violation(Required):

This field is required.

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Please indicate if you have previously submitted an allegation regarding this student

Date of Violation(Required):

This field is required.

Campus(Required):

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Please identify the campus where the violation occurred.

Student Information

Name of Student

Student ID Number

Email address

Faculty Questions

Please select the violation type(s):(Required)

Plagiarism Cheating Duplicate Work Facilitating Academic Dishonesty Fabrication Other

You must make at least one selection.

Course in which violation occurred:(Required) This field is required.

Semester in which violation occurred:(Required) This field is required.

Date(s) that the instructor discussed allegation with student:(Required) This field is required.

Provide a brief summary of the allegation and evidence. You may also attach supporting documents below.(Required) This field is required.

Academic sanction assigned (following the discussion of the allegation(s) with student):(Required) This field is required.

Supporting Documentation

You may attach any supporting documentation or other relevant information used in making determination for inclusion in this academic record. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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Background Information

Student Information

Faculty Questions

Supporting Documentation

Submission