Academic Dishonesty Form

Reporting Academic Dishonesty Form

In addition to this form, please email all supporting documentation to dos@csusm.edu.

For Copies or Originals of the Assignment(s):

Please highlight the areas of alleged academic dishonesty on the student's assignment and provide the source of dishonesty (e.g. website or other student's assignment).
If multiple sections of alleged dishonesty exist, please match the assignment and source of dishonesty with corresponding numbers.

If you would prefer to complete this form in a Word document and submit it via email, please call our office at (760) 750-4935, or email us at dos@csusm.edu.

More information is available from the Office of the Dean of Students at (760) 750-4935, Jennie Goldman (jgoldman@csusm.edu), or Dilcie Perez (dperez@csusm.edu). Please don't hesitate to ask any questions or to seek advice in pursuing an incident.

*Student First Name		Student First Name is a required field!
*Student Last Name		Student Last Name is a required field!
*Student ID Number		Student ID Number is a required field!
*Faculty Name		Faculty Name is a required field!
*Faculty Contact Info.		Phone or Email Faculty Contact Info. is a required field!
*Title/Course Number		Ex. HIST 131 Title/Course Number is a required field!
*Date of Alleged Incident		Date of Alleged Incident is a required field!
*Assignment's Percentage of Final Grade		Assignment's Percentage of Final Grade is a required field!
*What percentage of the assignment is allegedly dishonest?		What percentage of the assignment is allegedly dishonest? is a required field!
*Provide your policy on academic dishonesty and how this is shared with the students.		Faculty have "the responsibility to clarify their positions on academic dishonesty to their class early in each class." Policy also allows faculty quite a bit of latitude in how to deal with individual incidents of academic dishonesty, from failing an assignment to failing the class. What is this faculty member's policy and how it¿s shared? If this is included in the syllabus, please include a copy. If not on the syllabus, how do the students know how an individual faculty member will respond to academic dishonesty? Provide your policy on academic dishonesty and how this is shared with the students. is a required field!
*Provide a brief description of the incident.		Is this plagiarism? How can you tell? Can you identify the source? Is this cheating on an exam? Collaboration on an individual project? Forged signature? Provide a brief description of the incident. is a required field!
*Describe any contact with the student since the incident (Include copies of any email communication)		Describe any contact with the student since the incident (Include copies of any email communication) is a required field!
*Describe any action already taken		i.e. grade for the assignment Describe any action already taken is a required field!

Submit to Dean of Students Office