Fillable 2017ReportofStudentAcademicDishonesty - 2017 ReportofStudentAcademicDishonesty.rtf

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2017ReportofStudentAcademicDishonesty - 2017 ReportofStudentAcademicDishonesty.rtf

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University of Hawai`i at Hilo
REPORT OF STUDENT ACADEMIC DISHONESTY
Purpose: In order to maintain records of students who are found responsible for academic dishonesty,
the Vice Chancellor for Student Affairs office invites you to complete this form. If the student is
f
ound
responsible for academic dishonesty again in the future, a faculty member or judicial officer may
t
ake
the information from this record into consideration when determining an appropriate sanction against
the student. Please submit this form to the Vice Chancellor for Student Affairs office by sending i
t
through campus mail, faxing it (974-7691), dropping it off in Room 124 of the Student Life Center
,
or
sending it as an email attachment to Tim Moore at tim.moore@hawaii.edu
STUDENT NAME
ST
UD
EN
T
’
S
ID NU
MBER
Pro
f
e
ss
o
r/
I
n
s
t
ru
ct
o
r
(p
ri
n
t
)
D
e
p
a
rt
m
e
n
t
Course
Al
ph
a
/
N
u
m
b
e
r
Se
m
e
s
t
e
r/
Ye
a
r
Bri
e
f
l
y
describe the
c
i
rcu
m
s
t
a
n
ce
s
i
n
w
h
i
ch
the student was
found
re
s
pon
s
i
b
l
e
for
academic
d
i
s
hon
e
s
t
y.
What
a
c
t
i
on
d
i
d
you
take
to
ho
l
d
the student
re
s
pon
s
i
b
l
e
for
academic
d
i
s
hon
e
s
t
y?
□
R
e
qu
i
re
d
the student
to re-do
the
a
ss
i
gn
m
e
n
t
□
Gave the student a
f
a
ili
ng
or
reduced grade
for
the
a
ss
i
gn
m
e
n
t
□
Gave a
f
a
ili
ng
or
reduced grade
for
the
cou
rs
e
□
Other
(e
x
p
l
a
i
n
)
Any
a
dd
i
t
i
on
a
l
co
mm
e
n
t
s
:
TO THE STUDENT: By signing below, I acknowledge that I have read this form
.
Student
S
i
gn
a
t
u
re
D
a
t
e
Pro
f
e
ss
o
r/
I
n
s
t
ru
ct
o
r
Signature
Date
4/4/2007
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Completed 23 February 2020

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