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Academicdishonestyform

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7-11-17
1
College of Arts and Sciences
REPO RT O F ACAD EM I C D I SH O N ESTY
Please review the information provided on the following website:
http://www.slu.edu/arts-and-
sciences/student-resources/academic-honesty.php. Rules of procedure and evidence applied in civil or
criminal court actions shall not apply in the investigation, review, or complaint processes related to
academic dishonesty. Until a formal finding of a violation has been reached, all instructors and members
of the college faculty, staff, and administration involved with a complaint shall take appropriate
precautions to maintain confidentiality concerning the name of the accused, the nature of the complaint,
and supporting evidence, except insofar as such information must be divulged in order to investigate the
allegations or to conduct a hearing. If a violation is found, disclosure shall be limited to that initiated by
the Dean of the College as specified in Section VI.G below. If no violation is found, all record of the
complaint shall be destroyed and the nature of the evidence and the proceedings shall remain confidential.
Section I: Student and Course Information
Instructor must fill out all requested information in this section.
Student: ________________________________ Banner ID: ________________________
Student SLU email: _____________________________
Student’s Major: _________________________ College/School: ________________________
Course Title: _____________________________ Instructor: ________________________
Course Number & Section: _________________ Course CRN: ________________________
Department: ____________________________ Date of alleged misconduct: _____________
Instructor’s name (print): _____________________________________
Instructor’s email _________________________________________
Instructor’s signature: _______________________________________ Date: ____________
Section II: Case Information
Instructor must fill out all requested information in this section.
1. Misconduct alleged against the student:
2. Evidence supporting the charge:
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3. Which sanction was imposed by the instructor? (Please check all that apply):
a. _____ Zero on the assignment or exam
b. _____ Lowered grade in the course. Indicate the imposed lower grade for course _____.
c. _____ Other. (Please specify):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. Academic Dishonesty Violations are classified as Class A or Class B. Choose the class that best
describes this violation.
a. ________ Class A violation b. ________ Class B violation
Section III: Student Notification
The student must be notified in person or in writing regarding the academic dishonesty charge. Options
for notification are provided below. Instructor must fill out all information in this section.
5. How was the student notified of the outcome at this time? (Please check one):
a. _______ Student was notified in person of each of the following:
(1) the sanctions being imposed by the instructor
(2) that the student has one week from the date notified to appeal the decision of a Class
A violation to the Department Chair. (Note: Class B Violations will be automatically
adjudicated by the College Committee on Academic Honesty.)
The student acknowledges he/she has been notified of the sanctions imposed by signing
and dating on the following lines.
Student’s name: ______________________________
(Please print)
Student’s signature: _________________________________ Date:_________
b. _______ Student was notified by email or through USPS via a certified, signature-
required letter. Be sure to notify the student that with a Class A Violations, he/she has
one week from the date notified to appeal this decision to the Department Chair and
include a copy of the correspondence with this form. (Note: Class B Violations will be
adjudicated by the College Committee on Academic Honesty.)
6. Disposition of the case: (Please check one):
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a. _____ The instructor has imposed sanctions for a Class A violation and the student
waives the right of appeal. In this case the instructor will send this form and all
physical evidence to Gary Barker, of Undergraduate Education, College of Arts &
Sciences, Verhaegen Hall 218. The rest of this form does not need to be filled out.
b. _____ The instructor has imposed sanctions for a Class A violation and the student
hereby appeals the case to the Department Chair. The instructor will present this form
and all evidence to the Department Chair. Refer to Section IV.
c. _____ The instructor has imposed sanctions for a Class B violation. (Proceed to Section
V with the instructor forwarding this form and all evidence to the Department Chair.)
Section IV: Department Appeals for Class A Violation (only filled out if question 6b is checked:) In a
Class A violation case the student has the right to appeal the case to the Department Chair for the course
within which the violation occurred. The Department Chair should fill out this portion of the form and
sign where indicated.
7. Provide the printed name of the Department Chair who facilitated this appeal:
__________________________________________
8. Date of the appeal: ___________________
9. Provide the location of the appeal: _________________________________
10. The student and the instructor have the right to ask an advisor or witness to be in attendance
during the appeal.
a. ______ N/A no advisors/witnesses present
b. ______ Student had an advisor/witness present. (If yes, answer 10d.)
c. ______ Instructor had an advisor/witness present. (If yes, answer 10d.)
d. If 10b or 10c was selected, please indicate the name of the advisor/witness, address, and
telephone number and for whom they acted as an advisor.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
11. What was the outcome of the informal Department hearing?
a. _______ The Department Chair agrees with the sanctions imposed by the instructor. The
student will receive a copy of this Report and will be notified that he/she has the right to
request an appeal of the case to the Academic Honesty Committee. In order to appeal,
the student must submit a letter of appeal to the Department Chair within seven days
from receipt of this report.
7-11-17
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i. ____________ Date student was notified.
b. ______ The Department Chair’s decision is to alter the sanctions imposed by the
instructor. (See Section III.3 and III.4 for sanction options.) Please provide justification
on an additional sheet of paper.
c. ______ The Department Chair dismisses the case. Please notify the student that the case
has been dismissed and all evidence of the case has been destroyed. No further action is
required.
12. Did the student appeal the decision of the Department Chair? ______ (yes) ______ (no)
Chair’s name: ________________________________________
(Please print)
Chair’s signature: ____________________________________________ Date: _____________
Department: ___________________________________________________________________
Upon hearing from the student regarding an appeal or after seven days, whichever is the shortest time, the
Department Chair will forward this form along with all physical evidence to the Committee on Academic
Honesty, c/o Gary Barker, Associate Dean of Undergraduate Education, College of Arts & Sciences,
Verhaegen Hall 218.
Section V. Class B Violations
In a Class B violation case, the Department Chair shall immediately refer the case to be adjudicated by
the College Committee on Academic Honesty. The Department Chair shall provide the Committee with a
written summary of the allegations, the results of the initial investigation, and the findings and sanctions,
if any, that emerged from any prior level of review or proceeding. Please send this form, Department
Chair summary letter, and all physical evidence to the Committee on Academic Honesty, c/o Gary
Barker, Associate Dean of Undergraduate Education, College of Arts & Sciences, Verhaegen Hall 218.
Cases shall be referred to the Committee as soon as reasonably possible following the initial report of a
violation.
Chair’s name: ________________________________________
(Please print)
Chair’s signature: ____________________________________________ Date: _____________
Department: ___________________________________________________________________
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7-11-17
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Completed 15 November 2019

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