Academic Integrity Reporting Form

Instructor Information

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Your Full Name:

Your Office/Department:

Your Phone Number:

Your Email Address:

Email address must be of a valid format.

College(Required):

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(e.g. CAS, SBA, HSN, etc)

Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Course Number:

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(Course Number)

Involved Parties

Please include all parties involved

Name or Organization

Select Role

ID Number

Phone Number

Email address

Major

Questions

Please Identify any issues of concern (check all that apply):(Required)

Unauthorized assistance on an examination

Falsification or invention of data

Unauthorized collaboration on an academic exercise

Plagiarism

Misappropriation of resource materials

Unauthorized access of an Instructor's file or computer account

Other serious violation as established by the Instructor

You must make at least one selection.

If you selected "Other serious violation..." above, please specify below: This field is required.

Description of events that led to allegation of academic integrity violation; (e.g., grounds for allegation, evidence, etc. Attach relevant documents including course syllabus)(Required) This field is required.

Are there Witnesses to the Allegation? 1) Witnesses may reserve the right to remain anonymous. 2) If there are witnesses, please include in the involved party section. 3) If the witness desires to remain anonymous, indicate that the witness wants to remain anonymous in the involved party section. 4) Witnesses are not essential in reporting a violation. In those situations where witnesses are available, it may be important to the hearing committee process.(Required) This field is required.

Summary of Contact with Student and Students Response to Allegations: 1) Unless it clearly appears that there has been no violation of Academic Integrity policy, the instructor or supervisor must contact the person who may have engaged in the dishonest act and give that person the opportunity to deny or explain with respect to the allegations. If the person fails to respond, then the instructor or supervisor will notify the appropriate dean who will attempt to contact the person on behalf of the instructor or supervisor. 2) Discuss any new information that was gained after discussing the situation with the student(s) involved.(Required) This field is required.

After contact with the student, do you believe that a Serious Violation has occurred? 1) A Serious Violation includes: unauthorized assistance on examination, falsification or invention of data, unauthorized collaboration on an academic exercise, plagiarism, misappropriation of resource materials, unauthorized access of an Instructor's files or computer account, other serious violation of academic integrity as established by the instructor. The alleged violation will be referred to an Academic Integrity Hearing Committee 2)An Infraction can be: a. Any unintentional act which, if it had been intentional, would be a Serious Violation, and, b. Any violations of the rules or policies established for a course or academic exercise by the course instructor or supervisor of the academic exercise is an Infraction in that course or exercise, if such a violation would not constitute a Serious Violation.(Required) This field is required.

Sanctions imposed by instructor: 1) Sanctions that may be applied for an infraction include, but are not restricted to, reduction in grade, withdrawal from the course, requirement to retake part or all of the course, additional work. This field is required.

Supporting Documentation

Please attach any supporting documentation and course syllabus. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Instructor Information

Involved Parties

Questions

Supporting Documentation

Submission