Fillable Scholastic Dishonesty Report Form The University of Texas (University of Texas at Tyler)

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Scholastic Dishonesty Report Form The University of Texas (University of Texas at Tyler)

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The Scholastic Dishonesty Report Form The University of Texas (University of Texas at Tyler) form is 2 pages long and contains:

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  • 2 check-boxes
  • 13 other fields

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File type: PDF

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Scholastic Dishonesty Report Form
The University of Texas at Tyler
PART I: TO BE COMPLETED BY THE FACULTY MEMBER (Attach documentation.)
Student Name ___________________________________ Student ID Number ______________
Course Number, Section, and Name (or other Academic Endeavor)
______________________________________________________________________________
Semester and Year __________________________ Date of Alleged Act___________________
Concise Description of the Alleged Act of Scholastic Dishonesty
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________ ____________________________________
Signature, Faculty Member Date
PART II: TO BE COMPLETED BY THE STUDENT
I hereby acknowledge that I have been notified that the policy and procedures for scholastic
dishonesty are located at http://www.uttyler.edu/housing/ScholasticDishonesty.htm and that I
have received this form containing the charge of scholastic dishonesty and the recommended
disciplinary penalty to be imposed.
____________________________________ ____________________________________
Signature, Student Date
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PART III: TO BE COMPLETED BY THE STUDENT
_____ Section A: I hereby acknowledge that I committed the act of scholastic dishonesty
described in Part I above.
_____ Section B: I hereby deny that I committed the act of scholastic described in Part I
above and hereby request a hearing.
____________________________________ ____________________________________
Signature, Student Date
PART IV: TO BE COMPLETED BY THE FACULTY MEMBER
Concise description of the disciplinary penalty(s) to be recommended for the act of scholastic
dishonesty described in Part I above.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________ ____________________________________
Signature, Faculty Member Date
PART V: TO BE COMPLETED BY THE STUDENT
I hereby confirm that I have been notified of the disciplinary penalty as described in Part IV
above and waive my right to a hearing. I understand that I have 14 days to appeal this sanction.
I understand that this recommendation will be forwarded to the Director of Residence Life and
Judicial Affairs for further action if warranted.
___________________________________ ____________________________________
Signature, Student Date
NOTE: After you have received notice of the penalty as provided in the Regents’ Rules, you
may appeal the penalty to the Director of Residence Life and Judicial Affairs as stated in the
Student Affairs Manual of Policies and Procedures.
07/24/09
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Scholastic Dishonesty Report Form The University of Texas (University of Texas at Tyler)

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Completed 24 July 2020

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