Department Chair’s Report of Cheating/Plagiarism
California State University, Fresno
Date of Departmental Hearing: _________________________
Name of Student: ________________________________ Student Id#: ___________________________
Instructor Initiating Departmental Hearing:
Department Chair/Designee Filing Report:
__________________________________
P
lease print your name above Dept Chair/Designee Signature Above
Are you the: Department Chair or Department Chair’s Designee
Date of Incident: _________________ Type of Incident: Cheating or Plagiarism
Course Information: _______________________________ ____________________ _____________________
Course Title Course Number Section Number
Summary of Incident: _________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
DEPARTMENT CHAIR’S/DESIGNEE’S REPORT OF THE DEPARTMENTAL HEARING
Date of initial faculty conference with Department Chair: _______________________
Was there a Faculty-Student Conference held on this incident prior to the departmental hearing? Yes No
Date of departmental meeting: _______________________
Please list all those present at the hearing: ________________________________________________________________
_________________________________________________________________________________
From that hearing:
Do you find that cheating and/or plagiarism did occur? Yes No
Briefly summarize your finding: ___________________________________________________________________
_________________________________________________________________________________
If yes, did the instructor impose ACADEMIC SANCTIONS? Yes No
If Yes: Give 0 or F for test/paper/assignment
Give F for course (semester)
Other: (Please explain.) ____________________________________________________________
If yes, do you recommend DISCIPLINARY SANCTIONS? Yes No
If Yes, please explain. ________________________________________________________________________
If sanctions were proposed, did the student accept the proposed sanctions? Yes No
_________________________________________________________________________________
Student Signature Indicating Acceptance of Proposed Sanctions [Optional]
Append copies of all correspondence to the student, including (1) initial written statement of the allegation and notice of the hearing as
described in APM 235, (2) written summaries of the hearing detailing the finding of the hearing and, if recommended, any sanctions.
CONFIDENTIAL
Note: If one or more incidents involving the same student are already on record with the Vice President for Student Affairs/Dean of Students,
a disciplinary review will be conducted because a pattern of unacceptable behavior is apparent.
Forward this report to Vice President for Student Affairs/Dean of Students (MS #JA67); mark the envelope “Confidential.”
Revised 6/2002
