Academic Incident Reporting Form Office of Student Integrity - A unit of the Office of the Dean of Students (404) 894-2566

Please note that the reporting individual should be the Instructor of Record for the course. Once this form is submitted, the system will automatically generate an email to the student(s), notifying them that you have forwarded their name(s) to our office. If for any reason you feel that this is not the best time to notify the student(s), please delay in submitting this form. Reporting Person Contact Information Please enter your contact information so that we can communicate with you regarding this academic incident.

Please describe your role: Staff Faculty Turned Self In Student Other First Name Last Name Email Address Phone Number

Course Information Please provide some details about the course where the academic misconduct may have occurred.

Course Subject (MATH, CS, CH E) Course Number (1001, 1512, 4803) Course Section (A1, L1, RPX) Course Term Fall Semester Spring Semester Summer Term Course Year 2003 2004 2005 2006 2007 2008 2009 2010 College Select one: College of Architecture College of Computing College of Engineering College of Sciences College of Management Ivan Allen College Other