Saint Louis University-Madrid Campus

Academic Dishonesty Report – Draft January 2017

Please review SLU-Madrid Academic Integrity Policy prior to completing this form. All faculty and staff involved with a complaint shall take appropriate precaution to maintain confidentiality concerning the name of the accused, the nature of the complaint and its supporting evidence. If no violation is found, all record of the complaint shall be destroyed, and the nature of the evidence and the proceedings shall remain confidential.

Section I: Student and Course Information: The instructor completes this section.

Student:______

Banner ID:______

Course (Subject, Number, and Section): ______

Academic Unit:______

Program Director/Department Chair:______

Instructor’s Name:______

Instructor’s Signature:______Date: ______

Section II: Case Information. The instructor completes this section.

  1. Misconduct alleged against the student (evidence attached):
  2. Date of alleged misconduct: ______
  3. Sanctions imposed by the instructor:a. ____ Lowered or failing grade on the assignment or exam

b. ____ Lowered or failing grade in the course; indicate grade ____

c. ____ Other (please specify):

Section III: Student Notification: The student must be notified in person or in writing regarding the academic dishonesty charge. Options for notification are provided below. The instructor completes this section.

  1. How was the student notified of the outcome at this time? (Check a. or b.)

____ Student was notified in person of the following:

  • the sanctions imposed by the instructor
  • that the student has one week from the date notified to appeal the decision to the program director or chair.
  • that this report will be forwarded to the Chair of the Academic Honesty Committee and will remain on file in the Dean’s Office.

The student acknowledges he/she has been notified of the sanctions imposed by signing and dating below:

Student’s Signature: ______Date: ______

____ Student was notified by emailof the following (attach copy and the student’s reply, if available, with this form).

  • the sanctions imposed by the instructor
  • that the student has one week from the date notified to appeal the decision to the program director/chair.
  • that this report will be forwarded to the Chair of the Academic Honesty Committee and will remain on file in the Dean’s Office.
  1. Disposition of the case (check a. or b.):
  2. ___ The instructor has imposed sanctions for a violation of SLU-Madrid’s Academic Integrity Policy, and the student waives the right of appeal. In this case, the instructor will notify the program director/chair and send this form along with all physical evidence to the Chair of the Academic Honesty Committee, c/o the Office of the Academic Dean. The rest of this form need not be completed.
  3. ___ The instructor has imposed sanctions for a violation of SLU-Madrid’s Academic Integrity Policy, and the student hereby appeals the case to the program director. The instructor will present this form and all evidence to the program director. Refer to Section IV.

Section IV: Departmental Hearings: The program director/chair or informal hearing facilitator completes this section.

For any violation of SLU-Madrid’s AcademicIntegrity Policy, the student has the right to appeal the case to the program director or chair.

  1. Name of the program director or faculty representative serving as “facilitator”:______
  2. Date student appeal received: ______
  3. Date, time and location of the departmental hearing: ______
  1. The student and the instructor have the right to ask an advisor or witness to be in attendance during the appeal.
  2. ___ N/A: No advisors/witnesses were present
  3. ___ Student had an advisor/witness present. Indicate the name and contact information of the student’s witness/advisor:
    Name:______
    Telephone Number:______E-mail Address:______
  4. Instructor had an advisor/witness present. Indicate the name and contact information of the student’s witness/advisor:
    Name:______
    Telephone Number:______E-mail Address:______
  5. What was the outcome of the informal departmental hearing?
  6. ___ The program director/facilitatoragrees with the sanctions imposed by the instructor. The student will receive a copy of this report and be notified that he/she has the right to request an appeal of the case to the Academic Honesty Committee. In order to appeal, the student must submit a letter of appeal to the program director within seven days from receipt of this report.
  7. ___ The program director/facilitator has decided to alter the sanctions imposed by the instructor. Please provide justification in a separate memo. The student will receive a copy of this report along with the memo and will be notified that he/she has the right to request an appeal of the case to the Academic Honesty Committee. In order to appeal, the student must submit a letter of appeal to the program director within seven days from receipt of this report.
  8. ___ The program director dismisses the case. Please notify the student and the instructor that the case has been dismissed and that all evidence of the case will be destroyed. No further action need be taken.

For a. or b. only: If the student was notified in person, the student signs here: ______Date: ______
If the student was notified in writing, attach email.

  1. Did the student appeal the outcome of the departmental hearing? Yes / No
    If “Yes,” enclose the student’s letter of appeal with this report.

Upon hearing from the student regarding an appeal or after seven days, which is the shortest time, the program director/facilitator will forward this report along with all physical evidence as well as a brief summary of any information deemed necessary not in the report itself to the Chair of the Academic Honesty Committee, c/o the Office of the Academic Dean.

Program director/facilitator’s signature: ______Date: ______

Section V: Review by the Academic Honesty Committee. The Chair of the Academic Honesty Committee completes this section.

To detect multiple offenses by the same student, the Chair of the Academic Honesty Committee shall compare each notification of a violation with earlier notifications on file in the Office of the Academic Dean.If no previous violation is on file, this report will be filed, and the case is closed. If a previous violation is on record, the Chair of the Academic Honest Committee will notify the student, instructor and program director, and the Committee will convene to review the case and decide further sanctions based on the nature of the violations. Note, if the student has appealed the case to the Academic Honesty Committee, the review for previous violations takes place only to determine final sanctions, once the hearing is concluded.

Name of Committee Chair: ______

Signature of Committee Chair: ______Date: ______

Academic honesty report form (Draft: Dec. 2016) / 1