The top portion of this form includes mandatory information needed for EACH
report. Attach all reports to an e-mail to honor@ksu.edu, Honor office at 215
Fairchild Hall. If you have any questions, please call or email (532-2594 OR
dallen@ksu.edu).
Case:
Date:
Time:
Place: 215 Fairchild Hall
Case Investigators
Faculty Member
Student Member
The following information needed only on the PERSON being interviewed.
Simply delete the other titles depending on who you are interviewing.
Reporter:
Rank or Classification: Campus or Local Phone Number:
Email Address:
Interview Summary:
Witness:
Rank or Classification: Campus or Local Phone Number:
Email Address:
Interview Summary:
Alleged Violator:
Rank or Classification: Campus or Local Phone Number:
Email Address:
Others Present (HIPE Member)
Rank or Classification: Campus or Local Phone Number:
Email Address:
Alleged Violation: (Example: Copying answers from another student’s
paper during an in-class exam.)
Based upon the information we have gathered during the course of the investigation
we:
_____ have determined that sufficient information exists to move into the adjudication phase.
_____ have determined that sufficient information does not exist to move into the adjudication phase.Your signature indicates that the above information is, to the best of your knowledge, a fair, accurate, and unbiased report of the interviews conducted during the investigation.
Student Case Investigator __________________________________Date_____________
Faculty Case Investigator __________________________________Date_____________
The Director has read the information contained in this report and concurs
with your assessment.
Director, Honor System
_________________________________________ Date _________________
Director's Signature