Within 14 calendar days following informal conference with the student, and any necessary investigation, fill out and send the following information:

Student Information

Name


Last:

First:

Middle:

IU ID#:

Instructor Information

Name


Last:

First:

Middle:

Title:

Phone:

E-mail:


Department:

Department address:

Course number:

Course title:

Incident

Date of incident:

Room number and building:

Date on which instructor met with student following incident:


Brief summary of incident (write as much as needed to convey story):


Instructor's academic sanction:


Save and complete this later

After providing your e-mail address and clicking "Save," you will receive an e-mail with a link pointing you to your saved session.


Your E-mail Address:





Route of Appeal: The student may appeal in writing to the Dean of the School or Director of the Unit where the course is offered within 14 calendar days after receiving the faculty member's written report. See the Code of Student Rights, Responsibilities, and Conduct and campus procedures for additional information.

Dean of Students Action: The Dean of Students has the authority to impose an additional sanction which may be any of the following: Disciplinary Probation, Suspension from the University, or Expulsion from the University. Within 21 calendar days after receiving the faculty member's report, the Dean of Students will notify the student if the Dean is considering the propriety of an additional sanction or if no sanction will be imposed. A route of appeal is available.

NOTE: This report will be sent by the Office of Student Ethics and Anti-Harassment Programs, on behalf of the faculty member, to the student, dean of the school where the course is offered, dean of the school in which the student is enrolled if different, and the Dean of the Faculties.