Fillable Academic-ir Incident Report (IR) California State University, Chico

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Academic-ir Incident Report (IR) California State University, Chico

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revised: 3/2018
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Academic Incident Report (IR)
Student Conduct, Rights, and Responsibilities
California State University, Chico
Date: ______________
________________________________ __________________
Name of Student Student ID Number
__________________________ __________________
Course Title & Name Instructor Name
Please indicate:
Report Only (SCRR file
created; no action taken)
OR
Referral (student
contac
ted; poss
ible di
scipline)
Witnesses: __________________________ ________________________
Incident Report is regarding (check all that apply):
Cheating Plagiarism Unauthorized Collaboration
Description of incident:
Is the student receiving an F for the course? Yes / No (circle one)
OR
Is the student receiving a Zero for the assignment? Yes / No (circle one)
Incident report can be sent by campus mail to zip 0105 OR submit by email to scrr@csuchico.edu. Include a copy of your
syllabus and any supporting documentation. For questions, please call (530) 898-6897.
Submitted by:
Name Dept.
Phone E-mail
12
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Academic-ir Incident Report (IR) California State University, Chico

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Completed 18 March 2020

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