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Dishonesty/ Academic Integrity Reporting Form


Use the Academic Integrity Reporting Form to report all potential violations of academic dishonesty (cheating and plagiarism), as stipulated in the Academic Integrity Policy (Academic Senate Policy F15-7).

Reporting Party Information:

 
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Instructor, Student, Staff, Associate Dean, Other
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e.g., CHEM 1A

Student(s) Involved

Involved party 1

Reporting Information

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Type of Violation(Required)
You must make at least one selection.
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How was the student notified of the alleged violations?(Required)
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If you are the instructor of record, have you informed the student of the academic sanction(s) imposed?(Required)
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Indicate the Academic Sanctions Assigned to the Student(Required)
You must make at least one selection.
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Indicate if this report is for reporting purposes only or if you recommend additional administrative sanctions.(Required)
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Have you advised your Department Chair and/or Associate Dean that you are alerting the Office of Student Conduct and Ethical Development of an Academic Integrity violation? The Office of Student Conduct and Ethical Development recommends that you advise your Department Chair and or Associate Dean of the Academic Integrity report you are submitting.(Required)
You must make at least one selection.
I acknowledge that if the academic integrity case becomes actionable and proceeds to a conference with the Student Conduct Administrator; or escalates to a formal hearing process because a student is disputing the charges and/or does not agree with the proposed sanctions; the faculty member may be contacted regarding the incident and/or to serve as a witness at a formal hearing.(Required)
You must make at least one selection.

Supporting Documentation

Provide all documents that pertain to the potential violations of academic dishonesty (cheating and plagiarism); e.g., original assignments, exams, e-mail correspondence, TurnitIin reports. Include a current version of your course syllabus below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission