Academic Honesty Violation Reporting Form
Please submit the following information so we can begin an academic honesty investigation.
Faculty Members full name:
e.g. John Doe
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Faculty Members position/title:
e.g. Associate Professor, Lecturer, etc.
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Department:
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Contact phone number:
xxx-xxx-xxxx
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Contact email address:
e.g. j.doe@suffolk.edu
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Date of incident:
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Course Title:
e.g. MKT-319-A
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Involved Parties:
Please only include student(s) who may have violated the Academic Honesty Policy or may have
witnessed such actions. Please include: Student Name(s), ID Number (s), and the Type of Involvement
(e.g. Participant, Witness, Victim, etc.) For example: John Doe, 1112345 – Participant.
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Description
Please provide a detailed description of the incident/concern using specific concise, objective language.
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I have supporting documentation (copy of paper, copy of exam, emails, research done through Safe Assign,
etc.) that supports this case. Please send the documentation to eching-bush@suffolk.edu.
☐ Yes
☐ No
Please send a copy of the syllabus to eching-bush@suffolk.edu.
Have you had a conversation with the student(s) about this incident?
☐ Yes
☐ No
If so, did you talk with the student about what to expect as next steps?
☐ Yes
☐ No
While the determination of responsibility and any sanctions will be determined by a Student Affairs
hearing officer, your recommendation for sanctions if the student is found responsible is important in that
process. What outcome would you recommend?
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A range of sanctions may be assigned, typically, an undergraduate student found responsible for academic
dishonesty receives an F on the assignment, Disciplinary Probation and required participation in an
academic honesty program. A graduate student found responsible for academic honesty received an F in
the course.
Once you have filled in all required information, please email this document and any above requested
documents to eching-bush@suffolk.edu. You will be contacted by an individual from the Dean of Student's
office if there are any questions and for follow up.