Faculty Handbook

Academic Honesty Report

Faculty Member


Appendix A
Western Connecticut State university Academic Honesty Report

(To be completed by faculty member)
I. Description of Academic Honesty Violation  
  1. Student’s Name___________________________________________________________________
  2. Faculty Member's Name_____________________________________________________________
  3. Academic Department_______________________________________________________________
  4. Course Label and Number_________________________ Section Number_______________
  5. Course Title______________________________________________________________________
  6. Date of Incident_________________________________ Time of Incident_______________
  7. Place____________________________________________________________________________
  8. Nature and Description of Offense_______________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
  ________________________________________________________________________________
  ________________________________________________________________________________
  ________________________________________________________________________________
  9. Witnesses to the Incident (if applicable):  
    Name_________________________________________ Contact Info __________________
    Name_________________________________________ Contact Info __________________
  10. Recommended Penalty by Faculty Member (check all that apply)
  ____ a. This is a warning of unacceptable academic conduct from the instructor. Nor further action
is contemplated.
  ____ b. Grade of “F” for the exam, paper, or assignments.
  ____ c. Grade of “F” for the course.
  ____ d. Recommend further university disciplinary action under CSU Student Code of Conduct Policy.
  ____ e. Other:_______________________________________  
       
    ______________________________________________ ____________________________
    (faculty member’s signature) (date signed)

 


Related Links: