ࡱ> DFC5@ bjbj22 $&XXYI$h h h 8  $$ ( !######$RfG"G \v8  !!  Juh 4j,r0,L@LLGG$$D h ($$h ý Community College Referral Form for Academic Violations Please complete this electronic form as fully as possible. The information you share may be made available to the student and should reflect only what you have observed or of which you have first hand knowledge. In order to ensure that the Colleges standards for academic integrity are enforced consistently, it is important that you report all incidents of academic dishonesty to the Office of Student Development no matter how small or minor they may appear. Students Name: ID: Dates(s) of Incident(s): Date of Report: Reported by: Department: Contact Phone: Check all that apply: ( Academic dishonesty such as cheating plagiarism (including plagiarism included in student publications or writings), or knowingly furnishing false information to the Colleges, or District; ( Unauthorized preparation, giving, selling, transfer, distribution or publication, for any commercial purpose, of any contemporaneous recording of an academic presentation in a classroom or equivalent site of instruction, including but not limited to handwritten or typewritten class notes, except as permitted by any district policy or administrative procedure; ( Dishonesty, forgery, alteration, or misuse of College or District documents, records or identification; ( Obstruction or disruption of teaching, research, administration, disciplinary procedures, or other College or District activities, including its public services function, or of other authorized activities; ( Theft or abuse of computer time, including but not limited to: (Please circle all that apply.) Unauthorized entry into a file, to use, read or change the contents or for any other purpose; Unauthorized transfer of a file; Unauthorized use of another persons identification and password Use of computing facilities to interfere with the work of another student, faculty member or college official; Use of computing facilities to send obscene or abusive messages, or to defame or intentionally harm other persons; Use of computing facilities to interfere with normal operation of the college computing system; Use of computing facilities for students personal benefit; ( Engaging in expression which is obscene, libelous or slanderous, or which so incites students as to create a clear and present danger of the commission of unlawful acts on College or District premises, or the violation of lawful College or District regulations, or the substantial disruption of the orderly operation of the College or District. ( Persistent, serious misconduct where other means of correction have failed to bring about proper conduct. ( Other violations of Student Code of Conduct:___________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Please provide a brief summary of the incident(s) (with dates and times) as they occurred here:  For Office Use only: ( No Action Needed. For documentation only. ( INFORMAL CONSULTATION REFERRAL The reporter may request a consultation with Dean of Student Development or Designee. The student may or may not be notified of the report but may not necessarily be required to meet with a school official. Informal referrals are for relatively minor violations or concerns and may be retained to determine if a pattern of behavior is observed that may lead to formal action. An informal referral will not necessarily result in any specific action. ( FORMAL DISCIPLINARY or CONCERN REFERRAL Please submit electronically or in hard copy to: John Cognetta OR Michele LeBleu-Burns College Disciplinary Officer Dean Student Development & EOPS Student Development & EOPS Hinson Campus Center Office #165 Hinson Campus Center Office #165 ACTION TAKEN: Rev.  DATE \@ "M/d/yy" 3/1/11 TIME \@ "h:mm AM/PM" 5:04 PM ?A   g h i j F G H I |})+,-M¸ӯӯӯӯӯӸӸӯםד׸ˊhvh/;CJh'h/;5CJ#jh/;UaJmHnHsHtHhHh/;CJ johvh/;hHh/;CJhvh/;5h/; hvh/; hHh/;hvh/;CJ h/;5CJ hvh/;5CJ 5@A  . / ^ _ g h F G [|}=$$$$$$$$$$$$$j$$v:$$v:$$v:$$v:$$$v:$$$ & Fgd/;gd/;$a$gd/;Y=*yz$$$$$$ $dNgd/;gd/; & Fgd/;*+LBDuvHIYZ[\]$$ $dNgd/;BIXYbcuv|~¾h/;mHnHujh/;Uh/;hvh/;CJhvh/;5CJhvh/;CJhvh/;5 hvh/; johvh/;hvh/;CJ $dNgd/;":p/;/ =!"#$`%@@@ NormalCJ_HaJmH sH tH DAD Default Paragraph FontRiR  Table Normal4 l4a (k(No List 4@4 'Header  !4 @4 'Footer  !P&@A./^_ghFG[|}=  * y z * + L BDuvHIYZ[\]0Pp0P0Pp00Pp0P0Pp0ʀ0Pp0ʀ0Pp0Pp0Pp0Pp0Pp0Pp0Pp0Pp0Pp0Pp0Pp0Pp0Pp0Pp 0Pp 0Pp 0Pp 0Pp 0Pp 0Pp 0Pp000000000000000ʀ0ʀ0ʀ0ʀ0ʀ0ʀ0ʀ0000000000000000000EP#3EP#3@0ɀ@0@0@@@0X%\0FHHK =  #$;CK @  @H 0( SS ( a-s2i0:rtsnitcu P   "? B S  ? Q y# tK}}*,/78:{Yb}}-  ) Yb333}}G + X}Y 2$6PZ0^`0o(. bb^b`hH. 2 L2 ^2 `LhH.   ^ `hH. ^`hH. L^`LhH. rr^r`hH. BB^B`hH. L^`LhH.2$6V l        /;* XY@}}rg}}`@UnknownGz Times New Roman5Symbol3& z Arial;Wingdings hզD FF J J $4dRRK#Q ? cDe Anza Community CollegeFHDA  Oh+'0d4  0 < H T`hpxý Community College.e AFHDAza HDANormal  rm12mMicrosoft Word 10.0@`4<@X@64@@϶uJ G2VT$mq ^   ."Systemr0  -@Times New Roman-  2 X -'2 XRev. tC,22 +3/1/1122222 +5:04 PMn2228Y 2  ,'{@Times New Roman- 2 D`/2 e Anza Community College;!`K:C"`DonKJ%,C!`C%%;C; 2 1  I@Times New Roman-C2 Z%Referral Form for Academic Violations N4'4''3!A:'Y';'T54;4Y!4T!:!4 ;:.- 2   , 2 X -e2 X<Please complete this electronic form as fully as possible. 8,,',,2N2,,2',,-!22,!2!N,'!20,'23''2,=2 a !The information you share may be i=2,2!2!N,22032'2-!,N.03,2 X]made available to the student and should reflect only what you have observed or of which you N,2,,2,,2,22,'32,2,22'2222!,!-,320H2,0223,2,22'-"2,22!2!H2,202222 qXhave first hand knowledge.2,2,!!'2,22223H,32,y2 qI In order to ensure that the Colleges standards for academic integrity  22!2-!2,2'2",2,2,C2,1-!'',22,!2'"2!,,,3,N,2-1!0.2 Xare enforced consistente,!,,3!2!-,2,22'',2}2 Lly, it is important that you report all incidents of academic dishonesty to 1'N22!,22,/22",22!,2,2,2'2!-,-2,N,2'222,'022 WXPthe Office of Student Development no matter how small or minor they may appear. 2,H!!-,2!822,2H-2,22N,222N,,!23H'N,2!N22!2-0O-0,22-,! 2 Wu . 2 X -@Times New Roman-"2 ?XStudents Name:8!88,8!!'H2S," 2 ?" 2 ? , 2 ? , 2 ?4 , 2 ?`  , 2 ?  , 2 ?  , 2 ?  ,2 ?ID:'H! 2 ? 6 2 X 6/2 %XDates(s) of Incident(s):H2!,'!'!2"'8,8,8!!'!" 2 %$ 2 % , 2 %4 , 2 %`  , 2 %  , 2 %  , 2 %  ,"2 %Date of Report:H2!,2"H,82,!! 2 % 7 2 X 62 X Reported by:H,82,!,882" 2  $ 2  , 2  , 2  ,2 4DepartH,82,"2 ` ment:tS,8!" 2 Z  2 2   , 2   , 2   , 2 Contact Phone:H28!2,!<828,! 2  7 2 ~X 6-+2 XCheck all that apply:sC2,,2,2,,22/ 2  .@Times New Roman- 2 L X "@Wingdings- 2 XoY- 2  -2 OAcademic dishonesty such as cheating plagiarism (including plagiarism included H,,2,N,2'222,'0'2-2,',2,,312-1-!'N!2,22212-1-!'N2,22,2 2 B &2 hin 2 2 , X ,2 , Tstudent publications or writings), or knowingly furnishing false information to the '22,2222,,22'2!H!21'!2!222H310!3"2'221!,',2!3!N,2222, 2 X ,,2 Colleges, or District;C2,1,'2!H'!, 2  -@Times New Roman- 2  X %- 2 q XoY- 2 q  -2 q  UnauthorizeH2,222!-,|2 q rKd preparation, giving, selling, transfer, distribution or publication, for d22!,2-!,321231',21",2'!-!2'!22222!222,,22!2! 2 q \ 2 q hany ,30 2 X ,2 Tcommercial purpose, of any contemporaneous recording of an academic presentation in ,2NN,!,,22!22(,2!-30,22,N22!,2,22'!,-2!2212!,2-,,2,N,3",',2,222 2 W X ,2 W Xa classroom or equivalent site of instruction, including but not limited to handwritten ,,,''!22N2!,222,,3',2!2'!2,222,22212222N,222,22H!,2 2 X , 2 o22 Xr typewritten class notes, except as permitted by any district policy or administrative !02-H!,2,,''22,(,3,,2,'2,!N,240-302'!,22.02!,2N2'!,2, 2 = X ,2 =  procedure; 2!2,,22", 2 = H .- 2 X %- 2 XoY- 2  -2 UDishonesty, forgery, alteration, or misuse of College or District documents, records vH'222,'0!3"1,#0,,",222!N'2',2!C2,1,3!H'!,22,2N,2'!,,2!2' 2 X ,&2 or identification;2!2,2!,,22 2 ! -- 2 X %- 2 VXoY- 2 V -M2 V,Obstruction or disruption of teaching, reseaH2'!2,222!2'!22222!,,,231",',->2 VN "rch, administration, disciplinary !,2,3N2'!,222',22,"0 2 X ,2 Sprocedures, or other College or District activities, including its public services s2!2,,22",'2!22-!C2,2,2!H'!,-,2,'2,2221'222,',!2,,' 2 <X ,M2 <,function, or of other authorized activities;!22,222!2!22,!,232!-,2,,2,' 2 <  -- 2 X %- 2 XoY- 2  -h2 >Theft or abuse of computer time, including but not limited to:=2,!2!,22(,2!,2N22,!N,2,22212222N,22 2 %  , 2 X ,12 (Please circle all that a!8,,',,",,,2,,2  pply.)230! 2  .- 2 X %-2 Ua.,@"Arial- 2 U -2 UOUnauthorized entry into a file, to use, read or change the contents or for any H2,222!-,2,2#022,!,22',!-,22!,2-21,3,,22,2'2!!3!,30'2 other 22,! 2  2 purpose;22!22', 2 4 -'-2 ;b.2- 2 ; -;2 ; Unauthorized transfer of a file;H2,222!-,2!,2'!-!2!,!, 2 ;  -'-2 c.,- 2  -j2 ?Unauthorized use of another persons identification and passwordH2,222!-,22',2!,222,!2,!'22'2,2!-,22,222,''H2!2 2  .'-2 !d.2- 2 ! -_2 !8Use of computing facilities to interfere with the work oH',2!,2N2231!-,,'22,!!,",H22,I2!2242 !v f another student, faculty f!,222,"'22,2!-,20'42 member or college official;fN,N2,!2!,2-2,2!!,, 2   -'-2 e.,- 2  -2 QUse of computing facilities to send obscene or abusive messages, or to defame or sH',2!,2N2231!-,,'2',2222',,3,2!,23'2,N,''-1,'2!22-!-N,2!'=2 y!intentionally harm other persons; 2,222,02,!N22,!2,!'22' 2 y  -'-2 f.!- 2  -2 NUse of computing facilities to interfere with normal operation of the college H',2!,2N2231!-,,'22,!!,",H222!O,22,!,222!2,,2-2,'2 _computin,2N2222 _P g system;1)0',N 2 _ -'-2 g.1- 2  -d2 ;Use of computing facilities for students personal benefit;wH',2!,2N2231!-,,'!2!'22,2!'2-!'22,2,2,! 2   -' 2 EX --                    ՜.+,0  hp  ý CollegeRA ý Community College Title !"#$%&'()*+,-./0123456789:<=>?@ABERoot Entry FuguG1Table\WordDocument$&SummaryInformation( 4DocumentSummaryInformation8;CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q