Date

Student's Name

ID Number

Address

Dear :

I am writing in regard to the (piece of work) which you submitted on (date) for (course). I am concerned there may be a breach of the Academic Integrity Policy on this piece of work. (Give more specific details of your concern, e.g., "Specifically, I am concerned there may be an act of plagiarism on the third page.")

I would like to meet with you to discuss my concern. I have scheduled an appointment for (date, time, location). If you are unable to attend this appointment, please reschedule by (date). I will be making an appropriate decision regarding any further action after this date.

Sincerely,

(Instructor's Name)

(contact information)