Honor Code Reporting Form

Background Information

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Date of incident(Required):

This field is required.

Location of incident(Required):

This field is required.

Involved Parties

Name

Select Gender

Select Role

UTCID

Questions

Please provide a detailed description of the incident/concern using specific, concise and objective language (i.e. Who, What, Where, When, Why, and How). This field is required.

Course Name & Number (e.g. "ART1050: Drawing I")(Required) This field is required.

Course CRN (e.g. 12345)(Required) This field is required.

If you are the course instructor, please indicate how you would like the violation to be adjudicated: (You may select more than one option)

Honor Code Waiver Agreement Honor Code Officer Hearing Honor Code Board Hearing Informal (Record-keeping only. *This can only be utilized if there is no grade change that will result.)

You must make at least one selection.

If you are the course instructor, please indicate if you are proposing a change of grade to an assignment, examination, or course:

Assignment Examination Course

This field is required.

If you are the course instructor, please indicate the proposed grade change for the assignment, examination, or course: This field is required.

Supporting Documentation

Please provide any supporting documentation, as well as a copy of the course syllabus and assignment or examination instructions (if available). 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission