Appendix J

Academic Dishonesty Allegation Form

( Senate:  11/29/07; President:  1/30/08)

Reporting Procedures 

For the purposes of reporting allegations of academic dishonesty, the term ‘reporting party’ includes probationary, tenured and temporary faculty, librarians, persons in academic administrative positions, counselors, coaches, and administrators of testing centers.  Teaching assistants, graduate assistants and staff should report allegations of academic dishonesty to their authorized University supervisor.  Allegations shall be made against individual students rather than groups of students. 

If the reporting party suspects that an act of academic dishonesty has occurred, it is his or her responsibility to take the following steps: 

1. Perform a careful review to determine that there is reasonable evidence to substantiate a claim of academic dishonesty.

2. Arrange an individual office conference with the student as soon as possible to present the student with the allegations, provide the supporting evidence and inform the student of the proposed academic consequences and the possibility of administrative sanctions if the charges are substantiated.  If the violation is discovered during the final exam period and the reporting party has not had a chance to speak with the student, the instructor should not assign a final course grade pending the outcome of the matter.

3. Provide the student with a copy of the Academic Honesty policy and explain the disciplinary process.  The student has five (5) business days to sign the form indicating whether he or she agrees with the charges and proposed academic consequences or whether he or she disagrees and requests an investigation with the Judicial Affairs Officer.  The student should understand that no grade shall be assigned unless the student agrees or until the Judicial Affairs Officer deems the charges substantiated.

4. The student may elect to resolve the matter at the office conference with the reporting party.
   • If the student agrees to the charges of academic dishonesty, he or she must sign this form to confirm.  The reporting party should explain that the form will be forwarded to the Judicial Affairs Officer for informational purposes and may be used for further administrative sanctions as appropriate.  The instructor can then assign the grade.
   • If the student does not sign in agreement, the reporting party should indicate so on the form.  In this case, the reporting party may not issue the proposed academic consequences until the matter has been investigated and resolved by the Judicial Affairs Officer.

5. Complete and forward this form to the Judicial Affairs Officer, Student Affairs Building, room 108.

6. Please include the assignment/exam in question and any other relevant information that substantiates the allegations of academic dishonesty.

 Please refer to the Academic Honesty Policy.  (http://www.calstatela.edu/univ/stuaffrs/jao) 

Student Name:  _______________________________ CIN:  ______________________ 

Student Phone Number:* ___________________________________________________ 

Student E-mail Address: * __________________________________________________ 

*For notification purposes only.  No confidential information will be conveyed via e-mail or voice mail. 

Class Title:  _______________________________  Course#: _______ Term: _________ 

Reporting Party’s Name: ____________________________________ 

Department/Division/School: _________________________________ 

Campus Extension:* ____________ 

Reporting Party E-mail Address:* ______________________________ 

Assignment for which cheating/plagiarism is alleged: ____________________________ 

Date of incident: _______________ 

Description of incident:  Please attach additional pages or supplementary report as necessary; also include copies of supporting documents, (e.g. copy of paper or exam).

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________ 

Notes from discussion with student or reason for not meeting with student:  (The reporting party and/or student may attach notes for submission to the Judicial Affairs Officer).

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________ 

Proposed Academic Consequences:

Academic consequences may be assigned by the reporting party when the student agrees that the act of academic dishonesty has occurred.  Administrative sanctions may be issued by the Judicial Affairs Officer:

Failing grade on assignment

            Failing grade in the course

            Alternative exam/assignment

            Other (Please specify):_______________________________________________ 

       I was unable to meet with the student.

      Please provide reason: __________________________________________________________________

      _____________________________________________________________________________________

      _____________________________________________________________________________________ 

      I have provided the student with a copy of this form. 

Reporting Party’s Signature:________________________________  Date:___________ 

If the reporting party is unable to meet with the student or the student declines to sign the form, please submit the form without completing the following information.

………………………………………………………………………………………………................................

For the Student:  Choose one of the two options below.  Please be advised that you have five business days to respond to the allegations: 

      I have spoken with the aforementioned reporting party about this matter.  I have read, understand and agree to      the terms of this agreement.  I understand that this form will      be forwarded to the Judicial Affairs Office. 

I disagree with the allegations.  I request that the matter by further investigated and resolved by the Judicial Affairs Officer. 

Student’s Signature:_______________________________________ Date:___________ 

Student’s Comments (Optional): _____________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

The reporting party should submit this form and supporting documents to the Judicial Affairs Officer, Student Affairs Building, room 108. 

The Judicial Affairs Officer is available to consult with the reporting parties and/or students at any time during the process.  The Judicial Affairs Officer can be reached at (323) 343-3812.