Academic Conduct Referral Form (OSI)

Background Information

Enable additional features by logging in.

Your full name:

Institute Affiliation:

Learn more

Please indicate Faculty, Staff, Student, or Other.

Your phone number:

Your email address:

Email address must be of a valid format.

Date of incident(Required):

This field is required.

Term of incident:

Learn more

(e.g. Fall 2022)

Location of incident(Required):

This field is required.

Learn more

Please select

Specific Campus:

Learn more

Please indicate Atlanta, GT Europe, GT Shenzhen, or Other

Involved Parties

Student Name (Alleged)

Select Role

GTID Number

Email address

Additional Information

If, as the reporting party, you selected faculty above, please further indicate the nature of your role as an Instructor by selecting the most accurate option below:(Required) This field is required.

If this referral is not being submitted by the the primary instructor/professor of record associated with the course designated within this referral, please provide their name and email address. Please put N/A if the you are submitting this referral as the primary instructor/professor of record.(Required) This field is required.

Please select the College associated with course indicated in the allegation(s):(Required) This field is required.

Please indicate the course/instruction type:(Required) This field is required.

Please provide the name of the Course in which the incident took place. Please provide the full course name as indicated in the catalog (e.g. GT1000 Freshman Seminar):(Required) This field is required.

Please provide the Name of the Assignment(s) associated with the reported allegation(s):(Required) This field is required.

Please provide the Value of the Assignment(s) associated with the reported allegation(s):(Required) This field is required.

Please provide a detailed description of the alleged Academic Conduct:(Required) This field is required.

Would you like to meet with an OSI Staff Member to discuss this report? This field is required.

Please indicate the requested Resolution Method:(Required) This field is required.

Supporting Documentation

Please include the course syllabus associated with this referral, as well as any photos, videos or other supporting documentation. Also, if the referred student has been notified, please provide information verifying the date of notification (i.e. email pdf, etc.). 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Additional Information

Supporting Documentation

Submission