AC 2-24-09 Att 1
REPORT OF CHEATING/PLAGIARISM
Student name________________________________ ID #___________________
Course_______________ Sec.______ Semester___________________
Type of assignment:
Evidence of the cheating/plagiarism:
(Attach the assignment and proof of plagiarism.)
Brief description of the cheating/plagiarism:
Penalty imposed:
Instructor conference with student: date ______________________
____ Infraction and penalty explained
____ Review of supporting materials
____ Notification that “Report of Cheating/Plagiarism” will be filed
Each signature below indicates only that the signing party has been made aware of but does not necessarily
agree with the action taken.
___________________________________ _______________________
Student’s signature Date
___________________________________ _______________________
Instructor’s signature Date
STUDENT RECEIVES COPY OF DOCUMENT WITH STUDENT’S AND INSTRUCTOR’S SIGNATURES
__________________________________________ ____________________________
Chair’s Signature Date
__________________________________________ ____________________________
Dean’s Signature Date
(File with the Office of Academic Affairs)
Received by Academic Affairs date___________________________
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