Whistleblower Policy Reporting Form

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Whistleblower Policy Reporting Form

If you choose to remain anonymous, it is not necessary to fill out the contact information. However, please keep in mind that your decision to elect anonymity may limit our ability to conduct an inquiry, if one is warranted, or to appropriately address the issue. For example, if you choose to remain anonymous, we will not be able to follow-up with you if we need additional information or have questions about he details of your complaint. In some cases, if we do not have sufficient information, we may be unable to act on your complaint. As a result the more information you can provide, the better chance we have of addressing any wrongdoing that has been committed. You can always request that your identity and/or contact information remain confidential to the extent possible. Only university officials that need to know will be apprised of the information, and only then when it is necessary.

Select the appropriate office that the form should be submitted:

Provost/Vice President for Academic Affairs

Vice President for Finance and Administration

Human Resources and Payroll Services

Person reporting actual or suspected wrongful conduct Section:

Name:

Title/Department:

Campus Phone:

Email Address:

Person suspected of wrongful conduct Section:

Name:

Title/Department:

Campus Phone:

Email Address:

Use this space to describe the alleged wrongful conduct. Include specific facts and any documents you have, as well as the names of any individual at Fitchburg State with whom you have discussed concerns.

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