#_________

FORMAL COMPLAINT

Alleging Academic Misconduct

Complaint’s name: Status: Faculty_____

Office Address: Staff_____

Administrator_____

Office Phone:

Charged Student’s Name

Address:

Phone:

Student Number:

I do hereby allege that the above-referenced student has committed the following act(s) or omission(s) of academic misconduct: (describe with specificity, indicating date, time, and place of occurrence, if known).

I have documentary or other evidence to substantiate these allegations:

Yes if yes, please attach

No if no, please explain basis for allegation(s)

I have met with the charged student on:

(date)

I acknowledge my willingness to appear and testify in any formal proceedings about this matter.

Date Complainant

c:\data\winword\Misconduct\Formal Complaint Form.doc