Please fill out completely:
Date Referral Submitted:
Person Filing Referral
If multiple students being referred, please fill out information for each.
Recommended Sanction (optional):
Student Being Referred
Course Name/Number/Section of Incident:
Date incident was discovered:
Location (If applicable):
Please describe your knowledge of the incident as it occurred. Include all relevant information
about how you came to believe that a violation of the Code of Academic Integrity occurred. In addition,
please submit all relevant supporting documentation (including copies of the coursework in question) to
the Center for Student Ethics & Standards. This can be done via e-mail, campus-mail or in-person.
Please note: The information you submit will be made available to the student(s) referred as part of the
adjudication process. As the Code states, the instructor must also provide a copy of the report to each
implicated student. In our experience, it's best for the student(s) to hear about the referral directly
from you before they hear about it from us.
Please include any recommended sanctions. These recommendations will be taken into consideration, however,
the final decision is made by the Coordinator of Academic Integrity or the Academic Integrity Council in the
case of a formal hearing.
For more information on the process and procedures related to Academic Integrity, please refer to the Code,
which can be found here: http://www.uvm.edu/policies/student/acadintegrity.pdf
Last modified January 24 2013 02:15 PM