Academic Misconduct Procedure Form A
A
University of West Florida
Office of Student Rights and Responsibilities
Academic Misconduct Procedure Form A
Incident Information
INCIDENT DATE
COURSE PREFIX/NUMBER
Student Information
FIRST NAME
COURSE NAME
LAST NAME
UWF STUDENT ID
Faculty Information
SALUTATION
FIRST NAME
LAST NAME
INSTRUCTOR EMAIL
INSTRUCTOR PHONE NUMBER
INSTRUCTOR CAMPUS ADDRESS
BUILDING #
DEPARTMENT
ROOM#
Alleged Academic Misconduct Violation(s)
Please select all of the alleged violations that apply.
A. Cheating
Using or attempting to use material or information where such use is not expressly permitted by the instructor.
B. Academic Theft
Obtaining examinations, quizzes, or other academic materials without authorization.
C. Plagiarism
Representing the words, data, works, ideas, computer program or output, or anything not self generated as one's own.
D. Resubmission of Work
Resubmitting a paper, assignment, or portion thereof that the student originally created for another assignment or
course.
E. Fabrication
Presenting, as genuine, any invented or falsified citation, data or material.
F. Bribery
The offering, giving, receiving or soliciting of anything of value to influence a grade or other academic evaluation.
G. Misrepresentation
Any act or omission taken with intent to deceive an instructor or the University so as to affect a grade, a student’s
academic performance or to gain admission to a program or course.
H. Facilitating Academic Dishonesty
Knowingly contributing to another's violation of the University's regulation/rule on academic misconduct or planning with
others to engage in academic misconduct or failing to inform the proper authorities when a violation has occurred
regardless of one’s participation.
I. Violation of Professional Standards or Ethics as Defined by the Academic Program
Office of Student Rights and Responsibilities
BLDG 21 Room 130
(850) 474-2440
[email protected]
www.uwf.edu/osrr
Recommended Sanctions
Please select all of the appropriate sanction(s).
Academic Integrity Module (mandatory training program)
Reduction of Assignment Grade (please provide sanction details)
Reduction of Course Grade (please provide sanction details)
Educational Assignment (please provide sanction details)
Other (please provide sanction details)
Office of Student Rights and Responsibilities
BLDG 21 Room 130
(850) 474-2440
[email protected]
www.uwf.edu/osrr
Academic Misconduct Procedure Form A
Incident Details
Please provide incident details (attach additional pages, course syllabus, and supplemental documents if necessary):
Provide the student with an opportunity to respond to the allegations.
Review the Academic Misconduct Procedure Form A with the student. Inform the student that they have five (5) business days to
review the information on the form, and either accept responsibility for the alleged violation(s) and the sanction(s) detailed above
and waive the right to a hearing, or not accept responsibility or the recommended sanction(s) and request an Academic
Misconduct Hearing.
Provide a copy of the completed Academic Misconduct Procedure Form A to the student.
Send the original signed and completed Academic Misconduct Procedure Form A to the Office of Student Rights and
Responsibilities (Building 21 Room 130), keep a copy of the form for the instructor's records, and notify the instructor's Chair
and College Dean.
Student Instructions
You have five (5) business days to complete the Student Response section of the form and return it to the instructor.
You are required to initial and check ONLY ONE (1) of the available options below. The following is not permitted: student refusal
to select an option, student selecting more than one option, or student amending/altering the option(s).
You are required to sign your name in the student signature field and print the date in the Signatures section below.
Be advised, the UWF Academic Misconduct Code states: a student shall not be permitted to drop or withdraw from a class in
which there is an unresolved allegation. A student who has been found responsible for a violation of the Academic Misconduct
Code shall not be allowed to withdraw from the class in which the violation occurred.
Failure to comply with these instructions will result in your case being forwarded to the UWF Academic Misconduct Committee for
a hearing.
Student Response
A. Accepts Responsibility AND Sanction(s)
student initials
Student accepts responsibility for the alleged academic misconduct violation(s) AND the
recommended sanction(s) detailed above. Student waives his/her right to an appeal and
understands that this form will be forwarded to the Office of Student Rights and Responsibilities as
part of their record there.
The Office of Student Rights and Responsibilities will oversee and document the completion of the
mandatory training program. Once the training program and all additional sanctions have been
successfully completed, this Academic Misconduct Procedure Form A shall be retained by the
Office of Student Rights and Responsibilities as a non-disciplinary record solely for the purpose of
ascertaining a prior history of academic misconduct and will be considered separate from the
student’s disciplinary record. The case shall then be considered closed without further
documentation of the misconduct.
B. Does Not Accept Responsibility OR Sanction(s)
student initials
Student does not accept responsibility for the violation(s) OR the recommended sanction(s)
detailed above. This case will be forwarded to the UWF Academic Misconduct Committee for a
hearing.
C. Student Failed to Appear OR Refused to Select an Option
Student did not meet/communicate with the instructor concerning the alleged violation(s) of
academic misconduct, or refused to select an option outlined above. This case will be
forwarded to the UWF Academic Misconduct Committee for a hearing.
Signature
Student Signature
Date
Faculty Signature
Date
Office of Student Rights and Responsibilities
BLDG 21 Room 130
(850) 474-2440
[email protected]
www.uwf.edu/osrr
Academic Misconduct Procedure Form A
Faculty Instructions
Describe the allegations against the student and review the materials and information that led you to conclude that a violation has
likely been committed.