Learner Malpractice Form Contact Details Centre Number: Centre Name: Centre Address: Your Name: Your Job Title: Email Address: Tel. Number: Relationship to Centre: Do you wish to remain anonymous? Please refer to our whistleblowing policy. Yes No Incident Information Date(s) of Incident: Time(s) of Incident: Qualification, unit or specification code: Learner Name(s) Batch Number(s) ULN Name(s) and role(s) of invigilator(s)/assessment personnel or other witness/witnesses: Individual(s) who gathered evidence Name: Role: Reason why suitable to gather evidence (e.g. experienced senior leader): Did any external people (e.g. local authority personnel, union officers) assist in the gathering of evidence? If so, please give details: Yes No If Yes, please give details: Have you and the individual proposed to gather evidence read the JCQ guidance on conflicts of interest and personal interest at sections 2.5 and 6.3 and Appendix 3 within the JCQ Suspected Malpractice Policies and Procedures? Yes No Does the individual proposed to gather evidence have any known conflicts of interest or personal interest in the outcome of the investigation? Details We’d like to understand what happened so that we can make sure we involve the appropriate NCFE personnel who will carry out an initial fact find. Please provide details of the full nature of the alleged or actual maladministration or malpractice, including any mitigating circumstances and the contents and outcome of any investigation carried out by personnel, e.g. the centre or yourself, relating to the issue. Details of the nature of the suspected or actual maladministration and / or malpractice, including details of how it was identified, by whom and when; and any evidence obtained: Externally Assessed (e.g. exam) Was the Warning to Candidates displayed outside the examination room? (either by means of a projector or in hard copy paper format) Yes No Had the candidate(s) been issued with a copy of the Information for candidates? (either electronically or a paper version) Yes No Were candidates reminded of examination regulations at the beginning of this particular examination? Yes No Internally Assessed Had the candidate(s) been issued with a declaration of authentication? Yes No Had the candidate(s) signed the declaration of authentication stating that all work completed was the candidate’s own? Yes No Was the Information for Candidates issued to the candidate(s) prior to signing the declaration of authentication? Yes No All Qualifications If the incident involves disruptive behaviour, did the candidate’s behaviour cause disturbance to other candidates? If the answer to the above question is yes and you wish to request special consideration for other candidates, please submit an application for special consideration in the normal way. Yes No If the incident involves the introduction of unauthorised material, is the unauthorised material enclosed? Yes No If the case involves plagiarism please provide full details (i.e. title, author, edition, website, etc.) of the material plagiarised and include copies if possible: If there are any other details you feel are relevant to this allegation, including mitigating circumstances, please give further information below: Supporting Evidence Please indicate below the supporting evidence submitted with this report. All relevant information and materials must be submitted at this time. Evidence submitted subsequently may not be considered. Evidence submitted with this form Statement(s) from invigilator(s) Statement from teacher/tutor/head of subject/assessor/internal verifier Statement from examinations officer Statement(s) from candidate(s) Statement from employer Seating plan of examination room Unauthorised material removed from the candidate(s) Copies of sources of plagiarised material Assessment and Internal Verification or Moderation records Other If other, please give details: Please ZIP/compress all files into one folder where possible before uploading, to ensure we receive all evidence provided. Upload evidence Upload evidence Upload evidence If statement(s) from the candidate(s) is/are not enclosed, please put a tick in this box to indicate that the candidate(s) has/have been given the opportunity to make a statement, but has/have chosen not to do so. Declaration I accept that NCFE will hold and process the information given electronically and will only use this information for the purpose of an investigation and in compliance with relevant data protection legislation. The content of this report and supporting evidence is factual to the best of my knowledge and I submit it knowing that it is to be tendered in evidence Please complete the captcha: