Student full name * Student ID number * Programme / course * Level / year of study * SelectLevel 3 / FoundationLevel 4 / Year 1Level 5 / Year 2Level 6 / Year 3Level 7 / PostgraduateOther 02 Assessment details Module / unit title and code * Assessment title * Date of submission * Date misconduct identified * 03 Reporting staff Reporting staff name & role * 04 Nature of misconduct Type of misconduct * PlagiarismCollusionContract cheatingFabricationExam misconductUnauthorised AI useOther Description of alleged misconduct * Turnitin / similarity score (%) If applicable. 05 Evidence & actions Evidence attached PDF, Word or image — max 10 MB. To attach multiple files, combine into a single PDF/ZIP. List / description of evidence Action taken to date
