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James
Madison University Honor Council
Name: __________________________________________ Office:_______________________________ Phone: _________________________ E-Mail:__________________ Date: _______________ II. Course Information Course Title: ___________________________ Course Number: ________________________ Semester: ______________________________ III. Student Information Name: ___________________________ Student ID Number: _________________________ Student Address (JMU): ___________________________________ _______________________________________________________ Phone: ___________________ E-Mail: _______________________ IV. Incident Information Date of Incident: ___________________ Date of Discovery of the Incident: _____________________ Description of Incident: ______________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ VI. Agreement Information Date of Agreement: _______________________________ Description of Penalty: _________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ I hereby certify that I have not and will not drop this class this semester. Name of Faculty Member: _________________________ Signature: __________________________ Name of Student: ________________________________ Signature: __________________________ Honor Council Coordinator: ________________________ Signature: _________________________ Comments: ___________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________
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