Academic Integrity

Comments

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Name(s) of Student(s) Involved

First Name

Last Name

Student ID Number

Instructor Name

First Last

Instructor Email

Course Title & Number

Instructor Phone Number

Date of Incident

Description of Incident

Please provide a description of the incident.

Faculty Action

Please check all that apply.

Warning

F for the Course

Lower Grade on the Assignment/Exam

Resubmitting an Assignment

Zero on the Paper/Assignment/Exam

Other

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Please Describe Action Taken.

As the Faculty Member, I have:

Met with the student(s) to discuss the alleged academic integrity violation.

Not met with the student(s) to discuss the allegation.

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Date of Meeting with Student

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Please Provide Rational for Not Meeting with the Student.

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