Version 1/2010

EXCELSIOR COMMUNITY COLLEGE

STUDENT AUTHORSHIP STATEMENT
Please read the following instructions before completing and submitting this form
with your item of assessment.

By submitting this statement I agree that:

I. The attached item of coursework is my original work and has not been submitted for assessment
before;
II. All sources of information that are not my own have been properly acknowledged;
III. The attached coursework conforms to regulations contained in the college’s Student Handbook (page
23) and has no plagiarised material. This includes:
a. Direct copying or paraphrasing from someone else’s work (printed or electronic) without
acknowledging the source;
b. Turning in someone else’s work as my own;
c. Using another person's data or ideas without acknowledgment;
d. Presenting a paper previously submitted for assessment – either in its entirety or in part;
e. Collaborating on an assignment which was meant to be independent work;
f. Copying, rephrasing, or quoting an author's exact words and citing a source other than where the
material was obtained.
g. Using wording that is very similar to that of the original source, but passing it off as my own
h. Taking material from the internet without acknowledgement of the source;
IV. Disciplinary action will be taken if Plagiarism or other acts of cheating are discovered.

ID#:
Name of Student:
Group:

Course: Course Code:

Email Address: Telephone #:

Name of Lecturer: Date Due:

Section Completed (For Group Work Only):

Signature of Student:

Date Submitted:
A statement of authorship must be completed by all students upon submission of coursework pieces – hard copy or
electronic. This is with the exception of those assessments consisting of an invigilated examination. For group
assignments, each student is required to complete a separate statement of authorship indicating his/her contribution.

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RECEIPT OF ASSIGNMENT
The student should complete all details except lecturer’s signature and date received. After the lecturer has signed, the
receipt should be detached and a copy retained by the student as proof of submission.

Student’s Name: Student’s ID#:

Course: Course Code:

Department: Group:
Received by Lecturer’s
(Lecturer’s name): Signature:

Date Due: Date Received: