Instructors' Academic Dishonesty Reporting Form

Background Information

Instructor's full name:

Instructor's position/title:

Date of incident(Required):

This field is required.

Time of incident:

Instr's College/School/Library(Required):

This field is required.

Course Title, Ex: ENGL 3000-01:

Please list the names of all students involved

Student's name

Select Role

ID Number

Questions

Instructors are obligated to discuss the alleged incident with the student. Have you discussed this incident with the alleged student(s)?(Required)

Yes, in person or by phone Yes, via email (no response from student) Yes, via email (received response from student) No

This field is required.

Please describe the academic dishonesty incident using specific concise language (who, what, when, where.) If you were able to reach the student(s), please include any response from the student(s).(Required) This field is required.

What action have you taken with this student?(Required)

warning failing grade for the assignment failing grade for the course other

This field is required.

Please provide the rationale for your action taken with the student.(Required) This field is required.

What additional action put in place by the Office of Community Standards (former Office of Student Conduct) do you think would be beneficial or supportive for the student to be successful at UWG? (I.E. conduct probation, research on academic dishonesty, tutoring, meeting with an Academic Support Coach, etc.)(Required) This field is required.

Please type in your office phone extension (9XXXX) for verification purposes.(Required) This field is required.

Supporting Documentation (paper, exam, etc.)

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Background Information

Please list the names of all students involved

Questions

Supporting Documentation (paper, exam, etc.)

Submission