Academic Dishonesty Reporting Form
Riverside Community College District ( __RCC __MVC __NC)
The faculty handbook, student handbooks, and college catalogs all refer to disciplinary procedures regarding plagiarism and
the various responses an instructor may take when dealing with such cases. They explain that an instructor may report the
case of academic dishonesty and how it was handled to an administrative official (designated here as the college Vice
President of Academic Affairs), so that it can be kept in a centralized file should there be another act of academic dishonesty
reported. The college handbooks, catalogs, and board policy all address the various administrative actions that may be taken
in response to a case or cases of academic dishonesty (expulsion is specifically cited in the case of a repeat offender).
Instructors should use this form to share information with the VP of Academic Affairs at their college regarding cases of
academic dishonesty and the resulting consequence in the class, and the Offices of the Vice President of Academic Affairs
will be the sole repository of these documents at their respective colleges to enable the discovery of repeat offenders; the VP
of Academic Affairs will address what further action to take according to the details outlined in the board policy and
respective college catalogs and student handbooks (which also all include information regarding the student’s rights to appeal
any charge of academic dishonesty and subsequent disciplinary action). This form itself (and any attached documentation)
does not determine any administrative action and should not be part of any permanent student record; it is only intended to
communicate information that should be kept on file until the student has left RCCD.
Semester and year of instructor’s finding of academic dishonesty:_______________________________________
Name and RCCD ID of student: _________________________________________________________________
Name of course & section number: _______________________________________________________________
Nature and date of violation as determined by instructor, including information on the specific project,
examination, or paper involved:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Is there supporting documentation to substantiate the violation as determined by the instructor?
___Yes ___No
If yes, please attach. If no, please briefly describe the reasons for concluding academic dishonesty has occurred:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Consequence of violation as determined by instructor:
___Failure for the assignment with opportunity for make-up work
___Failure for the assignment without opportunity for make-up work
___Other (please explain): ________________________________________________________
Has the student been informed of the instructor’s finding of academic dishonesty?
___Yes, I have had a face-to-face conversation with the student (Date: _____________)
___Yes, I have sent an email to the student (Date: ___________)
___No (please explain):
___The student has dropped the course or has stopped attending class
___Other reason: _________________________________________________________
If the student has responded to notification of the instructor’s determinations, please briefly describe the outcome:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Instructor Signature Date Instructor email address Instructor Phone
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