Academic Dishonesty Report Form

Please complete the following form to report proven or suspected cases of academic dishonestly.

Remember,

It is very important that you report all cases, even if you have handled them. Also, you MUST forward backup documentation and the student's 8 digit Foothill ID number (SID) to the Dean of Student Affairs or no action will be taken.

If all the information is provided, the reports will be placed in the student's file. No action will be taken unless the instructor has selected "proven." Again, it is critical that you report ALL cases, as accumulated "suspected" cases by multiple instructors for a given student can assist the Dean of Student Affairs and Division Deans in identifying patterns and resolving cases.

Please use this form to report one academic dishonesty violation at a time. Thank you.

Academic Dishonesty Report Form

Please note: All fields are Required!
Student Name:
Student ID number:
(8 digits, use no dashes)
Quarter:
Summer    Fall    Winter    Spring
Academic Year:
Course name and number:
(include section)
Instructor's Name: 
Phone number: 
E-mail:
Email Report To My Dean:
Occurrence of offense in THIS course:
First     Second     Third
Follow-Up with Student? (Check ALL that apply)
I have NOT contacted the student yet
(Verbal) Spoke to student in person
(Verbal) Spoke to student by telephone
(Written) Via US Mail
(Written) Via E-mail
Proven violation?
Circumstantial evidence (no hard evidence to prove it) 
Proven (have data and evidence to prove it)

Description of Violation: (be as specific as possible)
Description:

Action Taken by Instructor: (be as specific as possible)
Action Taken:

What remedy you are seeking from the Student Affairs Office?
Remedy:

2MG MAXIMUM
Use the Add attachment button to include any proof that you have to back up this claim. To add more attachments, click the Add Attachment button multiple times. NOTE: The maximum file size for ALL attachments combined can not exceed 2 Meg. If you have larger files, they must be delivered by alternate means.

IMPORTANT: In addition to submitting this form, you MUST forward the material (evidence) that demonstrates your allegation to Dean of Student Affairs. Without this information, she cannot adequately speak with the student about the reported allegation. Include a phone number to contact you for verification. If you have any questions, or to confirm that the form arrived at the Office of Student Affairs, please call Bill Frankeberger at x7241.

Upon submission, the report will be sent to the Dean of Student Affairs, your Division Dean or VP, and you (for your records). Thank you!
Form Validation:


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