Official Student Disciplinary Enquiry Form

Please complete this form in full to report any incident of academic dishonesty. Keep a copy for your record and send the original form, together with all original supporting documents, via e-mail or by hand (do not send via internal mail) to the Student Disciplinary Office (contact details indicated above).
NB! One enquiry form per student.

In terms of the Protection of Personal Information Act 4 of 2013, this document and all supporting documentation must be handled as strictly confidential.

Compulsory fields

Campus

Date reported:

Reported by:

Staff number:

Tel:

E-mail

Student:

Student number:

Module code:

School and Faculty:

Date of incident:

Type of incident:

Has the paper been graded / marked?

Graded / marked by:

Has a grade been given?

If so, what is the grade?

Did the student get an opportunity to repeat the assignment or test?

Did you have a conversation with the student concerning this enquiry?

If so, please provide details concerning the conversation or any confessions that have been made to you in short.

Do you recommend that the Student Disciplinary Office take further action?

Please provide your written statement, as School Director, of the events in the designated space below or on a separate document.

This section is compulsory and is of great value to the Student Disciplinary Office in the execution of a fair enquiry and hearing procedure. Please follow these guidelines when formulating your written statement: (1) please identify yourself; (2) mention the transgression that has been committed; (3) mention time, place, circumstance; (4) if applicable, mention witnesses.

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Student Judicial Services

Official Student Disciplinary Enquiry Form