Student Involved: ______________________________________________________________
Student ID: _______________________ Date of Incident: _____________________________
Designator and Course Number: __________ Section: ______
Term: F ____ S ____ SS ____ Year_______
Describe the incident of alleged scholastic dishonesty:
What action has been taken? Include any written or oral warnings or meetings with the student, what grade has been given and any other sanctions/penalties that have been determined.
Attach a copy, if possible, of the paper or assignment in question and any other relevant materials.
Reported by (print name): _____________________________ Phone: __________________
Date: __________________ Discipline _____________________________
Please submit this form to:
The Office of the Vice Chancellor for Student Affairs
309 Behmler Hall
600 East Fourth Street
Morris, MN 56267
Phone: (320) 589-6013
Fax: (320) 589-6399