Information about accused student:

First & Last Name:
Student ID:

Please list all persons who should attend a hearing, should the accused request one (TAs, witnesses, etc.) -- Use a comma to separate names.

Information about yourself:

First & Last Name:
Title:
Email Address:
Phone:

Course, Section Number, Campus & Term (if appropriate):

Date of discovery of possible offense:

Note: Accusations should be made within 2 weeks of discovery whenever possible. If this accusation is being submitted after the 2-week period, please include a justification in the box below:

Penalty you would like to recommend if the student fails to appeal or is found guilty:

Note: Generally a Q grade is automatically assigned for the course by the Academic Judiciary. Once the student completes the university's 10-hour academic integrity course, the Q is replaced by a course grade that reflects/recommends the penalty by the instructor and the Academic Judiciary Committee.

	0/F for assignment
	1 Final letter grade reduction
	2 Final letter grades reduction
	Redo paper with 1 grade reduction
	Fail Course

If you are reporting this incident after the conclusion of the semester, what course grade would the student have earned if there were no penalty (i.e., if he or she were to appeal and be found not guilty)? If the semester is currently in progress, leave this section blank.

Nature of the offense you are reporting, including description of evidence (NOTE: A copy of this report will be sent to the student.):