1. Last Name First M.I.

2.     ID Number

3.     Specific University Code Violation

CODE #10 ACADEMIC DISHONESTY:

General Description of Violation

You have been accused of violating the University Code of Conduct Item 10 (Academic Dishonesty).

You have the right to explain your side of the incident to the faculty member. If there is reasonable cause to believe that an academic integrity violation has occurred, an academic sanction will be assigned. Sanctions will be assigned while considering past academic misconduct, precedents for similar violations and specific circumstances of the incident. You have the right to:

·       Choose to accept the accusations and academic sanction, OR,

·       Deny the accusations and request a review before a College/Campus n Committee on Academic Integrity

In cases where a University Disciplinary sanction or "XF" grade may be applied the information may be referred by the faculty member or Academic Integrity Committee to the Office of Judicial Affairs for review.

If a hearing is held AND it is determined that you are found responsible for academic dishonesty the hearing outcome may; a) not change, b) increase, or c) decrease sanctions assigned. If you are found not responsible, all incident records are destroyed.

**Policies, rules, sanctions and procedures regarding academic integrity can be found in the Procedures for the Discipline System (http://www.sa.psu.edu/ja/procedures.html), the Office of Judicial Affairs web site (http://www.sa.psu.edu/ja) or Academic Policies, Rules & Procedures for Students (http://www.psu.edu/ufs/policies). FOR ADDITIONAL ASSISTANCE, YOU MAY CONTACT OTHER ADMINISTRATORS WITHIN YOUR COLLEGE, YOUR ACADEMIC ADVISOR, USG LEGAL AFFAIRS (IN 203 HUB) OR JUDICIAL AFFAIRS (IN 135 BOUCKE).

You may not drop or withdraw from this course to avoid a sanction for a violation of academic integrity. Any such drop action of the course will be reversed. If after notification of a violation of academic integrity, you fail to sign this form, the academic integrity adjudication process will go forward as defined by college procedures.

Read and initial the following statement:

_____I have read and understand the previous statements. I have received verbally or in writing a summary of the academic complaint and understand the accusations made against me.

Academic Sanction: ______________________________________________                  ____________________________________                  __________

                                                                                                                                                Faculty Signature                                  Date