University of Georgia
Office of the Vice President for Instruction
DATE
REPORT OF POSSIBLE ACADEMIC DISHONESTY
Name
Dr.
Prof.
E-mail
Course
Phone
Term
Ms.
Mr.
List the FULL NAME (including middle initial) and the UGA ID NUMBER of each student involved:
Name & UGA ID Number:
Name & UGA ID Number:
Name & UGA ID Number:
Name & UGA ID Number:
Is this matter is related to a thesis, dissertation, and/or funded research?
Yes
No
In the space below, briefly describe the circumstances, including the assignment(s) in question and details that have led you to believe that a violation of
UGA's academic honesty policy may have occurred. PLEASE NOTE: The information on this form will be shared with the student(s) listed above.
After reading the definitions of academic dishonesty in "A Culture of Honesty" (honesty.uga.edu), I believe this may be a violation related to:
Unauthorized Assistance
Theft
Plagiarism
Other
Lying/Tampering
Submit by Email
Save and send this completed Report of Possible Academic Dishonesty by e-mail to honesty@uga.edu,
fax it to: (706) 542-0544 or print and mail it to:
Deborah C. Bell
Office of the VP for Instruction
111 New College
Athens, GA 30602-1698
(706) 542-4336
Print Form