LEHMAN COLLEGE Faculty Report Form For Suspected and/or Adjudicated Incidents of Academic Dishonesty Instructor Name:________________________________________________________________ Dept:______________________ Tel. No:_________________ E-mail:_____________________ Course:_______________________ Section:_______________ Semester__________________ Student Name:_________________________________________________________________ Last 4 digits of student SS # ____________________ Date of Incident: ________________ Type of Incident: Cheating__________ Plagiarism___________ Other____________________ Description of Incident:__________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Did the student admit to the charge of cheating, plagiarism or other act of academic dishonesty? Yes___________ No___________ _____________________________________________________________________________ Have you resolved the matter informally? Yes__________________ No____________________ If yes, how? __________ A failing grade on the exam/paper __________ A failing final grade __________ Other (please explain) _________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Signature of Faculty Member_________________________________ Date:________________ It is necessary to complete this form to report any instance of suspected and/or adjudicated academic dishonesty. Keep the original along with supporting materials and send a copy of this form to the chair of your department. Copies must also be sent to the following offices: Office of Academic Standards and Evaluations Liliana Calvet , Director Shuster Hall Room 280 718-960-8106 Office of the Vice President for Student Affairs Shuster Hall Room 204 718-960-8241/8242