UNIVERSITY OF DAYTON
HONOR CODE VIOLATION INCIDENT REPORT
Student Name ID# Date of Incident
School or College of Student Involved
College of Arts and Sciences School of Education and Health Sciences
School of Business Administration School of Engineering
Course in Which Incident Occurred
Description of Incident
Was Penalty Assessed?
Yes No
Explanation of Penalty
Instructor's Signature Date
The term instructor may refer to any faculty or staff member.
The instructor must inform the student that an Honor Code Violation Incident Report has been initiated, and an
appeal procedure is available. Instructor's signature indicates that the student has been notified.
If the student does not discuss the incident with the instructor within five business days, or decides not to appeal, the
instructor shall inform the department chair or program director in which the incident occurred and send the report
form to the student's dean(s).
If the student decides to appeal the alleged incident, the report form will follow the student through the appeal
process and eventually the form will be sent to the student's dean(s).
Student's Signature Date
Signature only acknowledges that student is aware of accusation. Appeal process is on back of form.