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Academic Integrity Reporting Form

We ask that you complete all parts of this form so that your referral may be addressed appropriately.

Faculty Information

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Course Name:

Date of incident(Required):

This field is required.

Time of incident:

Location of Incident(Required):

This field is required.

Course Name and Number:

Involved Parties

Involved party 1

Name

Select Role

STUDENT ID Y Number

Questions

Please describe the incident exactly as it occurred. Include all factual information that my be relevant, including the name of the class and type of academic exercise or assignment. Did you directly witness the violation? What percentage of the assignment/exam/quiz was the student's own work?(Required) This field is required.

Which of the following acts did you determine the student was responsible?(Required)

Plagiarism False Citations Falsifying Academic Documentation (Grade Changing) Submitting false data Submitting the same work for multiple assignments Cheating Abuse of shared electronic media Use of electronic device Abuse of Library Privileges

You must make at least one selection.

Identify the academic remedy you assigned:(Required) This field is required.

Besides the academic penalty listed above, is there any action you would like Student Conduct to pursue against the student? If so, please select from the options below.(Required)

Letter documenting the incident

You must make at least one selection.

Would you like to be contacted about this case?(Required)

Yes please No thank you No preference

This field is required.

Please select your preferred method of communication (Choose all that apply)(Required)

Phone Email Please do not contact me further

You must make at least one selection.

Supporting Documentation

Please attach any supporting documentation, screenshots, or photos you may have regarding this case. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission

Email me a copy of this report