Faculty Academic Sanction Form
In accordance with AP Procedure 3100.3, Honest Academic Conduct, the following form must be completed whenever an
academic sanction has been imposed. The completed form must be given to the School Dean within 10 instructional days of
the imposition of an academic sanction. The School Dean must provide a copy to the Disciplinary Officer/Dean of Student
Affairs for documentation.
Faculty Name: Date of Incident:
Student Name: CSID:
Course:
Assignment/Exam:
Evidence of academic dishonesty:
What academic sanction was assigned?
Note: Sanction can only be related to the assignment in question.
Zero on assignment/test Re-do work/Re-take exam
Lowering of grade on assignment or test Other - Specify __________________________
Was an office conference scheduled with the student and Department Chair or designee
to discuss allegations and evidence? Yes No
Date of conference?
Who attended (name & title)?
If a conference was not held, please explain why.
Faculty Name & Signature: Date:
This section to be completed by the School Dean
Would you like this incident to be processed through BP Policy 3100, Student Rights, Responsibilities
and Administrative Process? Yes No
If yes, please include supporting documentation.
School Dean Name: __________________________________________________________________
School Dean Signature: _____________________________________ Date:___________________
SS-FASANC-12/10
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