Instructor’s Report of Cheating/Plagiarism
California State University, Fresno
Date of Report: __________________________________
Name of Student: ________________________________ Student Id#: ___________________________
Instructor Filing Report: ___________________________ _________________________________________
Please print your name above Instructor Signature Above
Instructor’s Department: ________________________________________________ ___________________________
Date of Incident: _________________ Type of Incident: Cheating or Plagiarism
Course Information: _______________________________ ____________________ _____________________
Course Title Course Number Section Number
Summary of Incident: _________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
INSTRUCTOR’S REPORT OF THE FACULTY-STUDENT CONFERENCE Faculty will complete this section.
Date of Initial Conference with Student: _______________________
In that conference: Did the student admit guilt? Yes No
Did you impose ACADEMIC SANCTIONS? Yes No
If Yes: Give 0 or F for test/paper/assignment
Give F for course (semester)
Other: (Please explain.) ____________________________________________________________
Did 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]
INSTRUCTOR’S REPORT OF THE DEPARTMENTAL HEARING Faculty will complete this section. (if applicable)
Date of official hearing: _______________________
Please list all those present at the hearing: ________________________________________________________________
In that hearing: Did you impose ACADEMIC SANCTIONS? Yes No
If Yes: Give 0 or F for test/paper/assignment
Give F for course (semester)
Other: (Please explain.) ____________________________________________________________
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
