Attachment II

Texas State University-San Marcos

Honor Code Review Form

Name of Student__________________________________ SS# ___________________

Department__________________________ Course# _________ Semester_________

Summary of Alleged Violation _______________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Date______________ Time__________ Place__________________________________

Course Professor or Instructor_______________________________________________

Decision of Faculty Member/Department Chair/Dean_____________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Acceptance of Administrative Disposition

I, the student whose signature appears below, DO accept the decision appearing above, I accept administrative disposition of the allegation against me in accordance with the Official Texas State Code of Student Conduct, and I knowingly and willingly WAIVE my rights to a hearing of the Honor Code Council and the right to appeal to the dean and the Provost/VPAA. I do understand that additional sanctions are/are not (circle one) being recommended by the faculty member to the Coordinator of Student Justice and my acceptance of this academic sanction does not constitute a waiver of any rights of due process regarding any additional sanctions that may be imposed.

________________________________________________ ________________________

Signature of Student Date

Non-Acceptance of Administrative Disposition

I, the student whose signature appears below, DO NOT accept the decision appearing above, and I DO request a hearing of the Honor Code Council in accordance with the UPPS No. 07.10.01. I understand that I have the right to appeal the decision of the Council to the appropriate dean and to the Provost/VPAA. I do understand that additional sanctions are/are not (circle one) being recommended by the faculty member to the Coordinator of Student Justice and my non-acceptance of this academic sanction does not constitute a waiver of any rights of due process regarding any additional sanctions that may be imposed.

________________________________________________ _______________________

Signature of Student Date

________________________________________________ _______________________

Faculty Member/Department Chair/Dean (circle one) Date

xc: College Dean

Student