	The purpose of this form is to report violations of the Student Academic Honor Code to the Office of the Dean of Students (ODOS). Once a report is submitted, the instructor will be contacted by ODOS in order to provide guidance as to how the case should be handled.

Type of Alleged Violation*

	Cheating
	Plagiarism

Other, please specify

2.	Date of Incident?*
	mm/dd/yyyy

3.	Name and Student ID# of Accused Student(s)?*

4.	Reporting Party (Your Name, UNCW Email, Phone Number)*

What is the best way to reach you?*

	Email
	Phone

6.	Description of Incident (Please provide all relevant details as to why you believe the student(s) to be responsible for academic dishonesty).*

Please Note: In the event that the accused student has a prior academic honor or significant prior non-academic conduct violation, the case will automatically be referred to the Academic Honor Board (AHB). If the accused student does not have a prior violation, the instructor has the option of meeting with the student in an attempt to broker a private resolution or the instructor can pass the case on to the Office of the Dean of Students for adjudication.