Assignment Cover Sheet
Faculty of Medicine
University of Otago
This form must be completed, signed and stapled to each piece of work submitted for assessment.
If this declaration is submitted in electronic format your typed signature(s)/student ID(s) will be sufficient.
Student details
Student ID(s):
Paper code:
Module:
Date submitted:
Assignment title:
Declaration
I have read and understood the University of Otago’s Dishonest Practice Policy described on the University of
Otago website www.otago.ac.nz/study/plagiarism/.
I understand that if I am involved in any form of dishonest practice I will be subject to disciplinary procedures
I declare that:
 This assignment is entirely my own work, all sources have been referenced appropriately and I have not
previously submitted this work for assessment in any other paper or programme;
OR
 In the case of assignments requiring group work, all contributors and contributions are recognized and the
work has been carried out in accordance with the guidelines provided.
AND


I have not been party to someone else’s plagiarism by collusion, allowing them to copy my work or helping
them to plagiarise.
There has been no fabrication of patient or clinical information in material involving actual clinical scenarios
or cases.
I am also aware that I have signed the student code of professional conduct which contains
the following.
7. Personal integrity and well-being; as a medical student I will:
7.1
Act with integrity in all learning and assessment situations
7.2
Not plagiarise another’s work or research and will abide by the
plagiarism/Dishonest Practice policy of the University of Otago.
……………………………………………………………………………………………………………………………………………….
For assignments that are anonymised for marking tear off signature
Signature(s)_______________________________________________________________
ID: