Academic Integrity Reporting Form

Faculty Report Form Incidents of suspected Academic Dishonesty (AIV-1)

It is necessary to complete this form to report any instance of suspected academic dishonesty. A copy will be sent to your email for your records and the Academic Department Chairperson. Please be sure to upload any supporting documentation to this form.

Instructor Name*

First Name

Initial (optional)

Last Name

Academic Department*

Telephone Number of the Instructor

Email of the Instructor*

Couse & Section*

Student Name*

First Name

Initial (optional)

Last Name

Student EMPLID*

Student Email

Date and Time of the Incident*

:

Location of the Incident*

Type of Report*

Formal Informal

Type of Incident*

Cheating Plagiarism Fabrication Academic Misconduct Falsification of Records and Official Documents

Other:

Offense*

First Offense Second Offense

Explanation of Incident*

Please attach all supporting documents

No File Chosen

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Do you have additional supporting documents to upload?

Yes No

Additional supporting documents

No File Chosen

File uploads may not work on some mobile devices.

Do you have additional supporting documents to upload?

Yes No

Additional supporting documents

No File Chosen

File uploads may not work on some mobile devices.

Did you speak to the student about the allegations?*

Yes No

A faculty member who suspects that a student has committed a violation of the CUNY Academic Integrity Policy shall review with the student the facts and circumstances of the suspected violation whenever feasible.

Your stated policy on academic integrity*

A failing grade on the activity A final grade of F in the course

Other:

Did the student admit to the charge of cheating, plagiarism or other act of academic integrity?*

Yes No

Signature of Reporter*

[clear]

Use your mouse or finger to draw your signature above

The disciplinary sanctions above are outlined in a pamphlet entitled Academic Integrity Policy at Queensborough Community College available in the Office of Community Standards (Library Building, Room 418), most offices on campus, Academic Departments, and online. If you agree with the charge(s) and accept the academic sanction assigned, the sanction becomes final. You should also note that one additional violation by the student will result in disciplinary action following the procedures of Article XV of the University Bylaws that may lead to suspension or expulsion.