Academic Integrity Incident Report Form

Academic Integrity: Meeting and Response Form
SUNY Cortland
PART A: (Faculty completes this section, using one form per student)
Faculty Name:
Course Title:
Semester:
Date of discovery of incident:
Meeting Witness:
Meeting Date:
Student’s Name:
Student ID #:
Preferred Email:
Local Address:
Current Phone #:
Major Code:
PART B (Faculty):
I have met with the student and witness identified above, to discuss an incident that may have been in violation of
College Policy (Handbook CH. 340). As a result of that discussion I concluded that (check one):
a) No violation had occurred
b) A violation had occurred.
In the case of a violation of College Policy, please describe the incident:
F
D
le P
Use additional pages if necessary (continue on page 2). Be specific in describing the incident and refer to College
Academic Integrity Policy (Ch. 340).
b
a
t
i
d
I have decided to impose the following penalty:
E
F
A
C
U
L
T
Y
Faculty’s Signature and date:
(Only the faculty/grievant should sign at this point before submitting the form. The
policy prohibits asking the student to sign before filing the form with the AGT Chair).
This form must be filed by the faculty with the AGT Chair (through the Provost’s office) within 5 working
days of the meeting described above. The AGT Chair will then request the student’s response. The student
must complete PART C and return the original form to Office of the Provost, SUNY Cortland, P. O. Box
2000, Cortland, NY 13045 or Provost’s Office, 408 Miller within 2 working days of receipt.
Student Completes PART C:
When “no violation” has been found, no further action by the student is required.
When a violation of College Policy has been found, a student may choose to accept or deny this
finding:
I accept the finding and penalty described above:
Signature and date:
I deny the finding and the penalty described above*
Signature and date:
S
T
U
D
E
N
T
I accept the finding, but wish to appeal the penalty described above*
Signature and date:
*Denying the finding and/or the penalty will begin the appeal process: students must file a copy of this form with the AGT Chair (c/o
Provost’s office, 408 Miller), within 2 working days of receipt from the AGT. Failure to file this form on time will deprive the student of any
opportunity to appeal findings and/or penalties imposed by the College. The updated Academic Integrity Policy can be found in Chapter 340
(page 50) of the 2006-2008 College Handbook and can be accessed at the following link: http://www.cortland.edu/handbook/index.html
Revised 10/07
Academic Integrity: Meeting and Response Form
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