Reporting an Academic Dishonesty Case

Today's Date:

Faculty/Reporter's Information

Name:

Department:

Campus Address:

Extension:

Email Address:

Course Information

Course Title:

Course Number and Section:

Date of Offence:

Details of Relevant Course Work:

E.g. - an essay worth 30% of course, an exam worth 50%

Student Information

Name:

ID Number:

Email Address:

Faculty the student is registered in:

□	Male

□	Female

Offence Information

□	Plagiarism

□	Cheating on a test or exam

□	Improper collaboration

□	Submitting the work of others

□	Multiple submissions of the same material

□	Falsification of data

□	Impersonation of another student

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□	False medical documents

□	Alteration of a grade

□	Alteration or fabrication of transcripts or official documents

□	Misrepresentation of academic credentials

□	Aiding another student to commit academic dishonesty

□	Mishandling of academic materials (e.g. preventing other students from completing academic tasks)

□	Other

Provide a brief description of the offence (facts leading you to be suspicious, steps you took to investigate, student's explanation, etc.). Please send the originals of all related papers to the Office of Academic Integrity - MUSC 211.