Notification of Academic Integrity Policy Violation
Great Falls College MSU
INSTRUCTOR DATE OF INCIDENT
COURSE NAME & NUMBER
STUDENT(S) INVOLVED: (Name & ID Number)
(Please use one form for each student involved in the incident.)
NATURE OF VIOLATION (Include a brief description of the incident and attach any documentation):
Cheating Falsification/Fabrication Tampering Plagiarism
Facilitation of academic misconduct Multiple Submissions Other academic misconduct
Description of Incident:
Incident discussed with student(s)?
Yes
No
If No, Why?
Witnesses?
Yes
No
If Yes, name(s):
Instructor's academic sanction [e.g., "F" grade or "0" score, etc.]
Oral reprimand Written reprimand (copy attached) An assignment to repeat the work or an alternate assignment
A lower grade or failing grade on the particular assignment or test A lower grade or failing grade in the course
Description of Sanction:
Instructor's Signature
Date
* Full
documentation of the incident should accompany the copy of this form that goes to the Associate Dean of Student Services
Revised October 2014
COPY DISTRIBUTION
Division Director
Associate Dean for Student Services
Associate Dean for Student Services
2100 16th Avenue South
Great Falls, MT 59405
406-771
-5133
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