MacEwan University
ACADEMIC INTEGRITY INCIDENT REPORT
Today’s Date: 1/12/2013 (please update)
INSTRUCTOR’S/REPORTER’S INFORMATION
Name:
Phone:
Department/Program:
E-mail:
Campus mailing address:
COURSE INFORMATION
Course title:
Course section:
Date of offense:
Details of relevant course work (eg. an essay worth 20% of course; exam worth 30%, etc.):
STUDENT INFORMATION
Name:
ID number:
Male:
Female:
COURSE OF ACTION
I am allowing the student to re-do the piece of academic work
I am reducing the student’s grade on the piece of academic work. Give details:
I am assigning a mark of zero on the piece of academic work
INCIDENT INFORMATION
Please indicate which of the following best describes the incident:
Plagiarism
Impersonation of another student
Cheating on a test or exam
False medical documents
Improper collaboration
Alteration of a mark
Submitting another’s work (eg. a bought paper)
Aiding another student to gain an unfair academic advantage
Multiple submissions
Mishandling of academic materials (eg. selling or distributing tests)
Falsification of data
Other (Please describe)
BRIEF DESCRIPTION OF THE INCIDENT
Please briefly describe how you became suspicious, the steps you took to investigate, the student’s explanation, and any other relevant information.
You may attach additional pages, if necessary. Please make copies of all the related papers before returning anything to the student, and keep this
material on file in case of a Hearing. Please do not send this information to the Office of Academic Integrity unless requested to do so.
Questions? Contact the Academic Integrity Coordinator at aio@macewan.ca or phone 780-633-3083.
FOIP Privacy Protection - The personal information requested on this form is collected under the authority of Part 2 of the Alberta Freedom of Information and Protection of Privacy
Act and protected according to provisions of that legislation and the MacEwan University Policy D7230: Information Security. It will be disclosed to the Academic Integrity Officer and
may be used to initiate action pursuant to MacEwan University Policy C1000: Academic Integrity. Some of this personal information will be entered into and retained in the Academic
Integrity database. Other uses and disclosures of this information may occur as described in various sections of the Academic Integrity Policy. Direct questions expressly related to
the collection, uses and disclosures of this information to the Academic Integrity Officer, MacEwan University, 7-266S, City Centre Campus. Phone 780.633.3083.