Academic Integrity Violation Report
The Academic Integrity Violation Report must be completed and submitted
to
the
Academic Chair when a
violation
of
integrity
is
alleged or established. The Staff /Faculty member
has
addressed
the
allegation or
violation
of
integrity
with
the
student. The Chair
has
final discretion on
the
penalty and consequences.
the
student has accepted responsibility.
the
student has
not
accepted responsibility.
Faculty/Staff Member Filing Report:
Name:
Program /Department:
Reported Student.
Name: Student
ID#
: Program:
Incident:
Date
of
Occurrence:
Details
of
Occurrence:
Other students associated
with
incident:
Names: Student
ID:
Program:
Faculty/ Staff Member's Signature: Date:
Student's Signature: Date:
Outcome (penalty/consequence):
Academic Chair's Signature:
Date:
revised June 2019
Academic Integrity Policy and Procedure - Appendix I