Fillable Name EMPL ID (complainant) Email Address Phone Number (Dickinson State University)

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Name EMPL ID (complainant) Email Address Phone Number (Dickinson State University)

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Name
(complainant)
EMPL ID
Email Address
Phone Number
Address
Name of individual (respondent) or individuals (respondents) against whom complaint is lodged:
What misconduct is being charged?
What facts are charges based upon? (What evidence supports the complaint? How may this be verified?)
Witnesses?
By signing this form, I certify that the above information is true and correct.
Signature
Date
Online Academic Misconduct
Report Form
Return forms to Academic Affairs, May Hall 119
or via email to: sharon.harris@dickinsonstate.edu
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Name EMPL ID (complainant) Email Address Phone Number (Dickinson State University)

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Completed 19 August 2020

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