No: Type of academic dishonesty: Cheating (the use or attempted use of unauthorized materials, unauthorized copying or collaboration) Fabrication (intentional misrepresentation or invention of any information) Plagiarism (the use of another s words, ideas, data, or product without appropriate acknowledgement) Collusion (assisting another to commit an act of academic dishonesty) Academic Misconduct (grade tampering, fraud, misrepresentation, obtaining or distributing any part of a test) Other: Summary of the incident (include date, time, and place): Student s explanation (admission of guilt, denial, comments, etc.): Instructor s action / recommendation for further action: Instructor s signature and date: Student s signature acknowledging this report and the opportunity to review procedures: (If student is unavailable or unwilling to sign, note how this report was communicated to student.) Student s signature and date: Action taken: (to be completed by Division Dean) Disciplinary admonition and warning by faculty member Academic penalty on assignment by faculty member Assignment of a lower or failing grade for the course by faculty member/Division Dean Disciplinary probation for academic terms by Dean of Student Development Suspension from Portland Community College for academic terms by Dean of Student Development Expulsion from Portland Community College by Dean of Student Development Other: Signature of Division Dean and Date: Please file this completed form in the Division Office and forward copies to the campus Dean of Student Development and the campus Dean of Instruction..
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