Section 4.01(a) of the Honor Code provides the requirements for filing an initial referral.
Instructions: Please complete this form (attaching additional pages if necessary), put it in an envelope, place it in the mailbox of the Associate Dean for Administration and Student Affairs, Annamaria Nields (mailbox located in Suite 200) If possible, please send an e-mail to firstname.lastname@example.org to notify her that the form is in her mailbox.
Your name (please print): ___________________________
Year (1D, etc.): _______
Your e-mail address: ___________________________________________
Your phone number: _____________________________________
Name of student(s) you are referring: __________________________________________
Year of the student(s) (if known): ____________
Class or activity involved in the incident: __________________________________
Professor of that class (if applicable): ________________________________________
Date of the incident: __________________________________
Approximate Date the alleged violation was discovered: ____________________
Describe the conduct that you allege was a violation of the Honor Code (attach additional pages if necessary).