Report Forms
Download and complete the following to make a formal report of an incident:
Report of Academic Misconduct
Introduction: A graduate student who is guilty of academic misconduct is subject to both academic sanctions and disciplinary sanctions. Disciplinary sanctions are determined by the Dean of Graduate Studies or, if the case reaches the Graduate Council, by the Graduate Dean on the basis of the recommendation of an appointed subcommittee of Graduate Council. Academic sanctions are determined by the instructor of record. In cases in which the student maintains his/her innocence of the charges, the instructor is asked to await the final decision of the Graduate Dean before imposing these sanctions, but the sanctions are ultimately at the discretion of the instructor. Academic sanctions, like any other aspect of a course grade or evaluation, can be appealed only through the Graduate Division policies for academic appeals.
This form should be completed and signed by student and instructor and forwarded to the Graduate Dean along with copies of evidence. A copy of this form should be kept by the instructor and the student.
Instructor ____________________________ Dept._______________________
Ext.___________ Email: ____________________________
Instructor's Campus Address: __________________________________________
Student_________________________________ ID#____________________
Department/Program _________________ Degree sought ______________________
Email ______________________________
Address _____________________________________________ Phone _____________
Quarter_____________________
Course (or relevant context of alleged misconduct) _______________________________
Date of Incident ___________________
Violation: ___ cheating ___ plagiarism ___ other (explain) ______________________
____________________________________________________________________
Instructor's Analysis (attach separate sheet, if necessary)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Evidence Attached (please list)__________________________________________
Proposed Academic Sanctions: ___ additional work ___ re-examination
___ exclusion from course ___ change of grade (explain)* ______________________
___ no credit for work in question ___ inclusion of incident in studentÀs narrative evaluation
Instructor's Comments (if any)________________________________________________
______________________________________________________________________
Student Comments:
__ I am guilty of these charges. (If so desired, student may give an account of any unusual or extenuating circumstances in the space below.)
__ I am not guilty of these charges. (Student is asked to give his/her account of the incident in the space below.)
Student comments: (Attach separate sheet if necessary.)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Student's signature____________________________________ Date__________
Instructor's signature__________________________________ Date__________
