Office of Community Standards and Student Conduct
022 Student Union
3640 Colonel Glenn Hwy.
Dayton, Ohio 45435
937-775-4240
ACADEMIC INTEGRITY VIOLATION FORM
Please inform the Office of Community Standards and Student Conduct of all violations of the Academic Integrity policy (cheating,
plagiarism, etc.).
Name of Student:
UID:
Name of Class:
Course #:
Name of Instructor:
Date/Time of Incident:
Name of Department:
Office Address/Phone:
Section:
Description of Incident: (Please include a copy of all supporting documentation/attach additional pages if needed)
For questions regarding academic misconduct, please contact the Office of Community Standards and Student Conduct at 775-4240.
Distribution:
Copy - Student: Send with Academic Integrity Violation Notification form
Copy - Faculty Member: Retain in file if found responsible or shred if case is dismissed
Copy - Office of Student Conduct and Community Standards: Forward if student is found responsible or referring to Academic
Integrity Hearing Panel
Revised 3-1-2010