Complaint Intake Form

Complainant Information:

First

Last

Your Work Email Address:

Your Personal Email Address:

Address

City/Town

State/Province

ZIP/Postal Code

Cell Phone:

Home Phone:

Work Phone:

Employer:

Address

City/Town

State/Province

ZIP/Postal Code

Relationship to the Institution

Other…

How would you prefer we contact you?

Work Phone

Home Phone

Cellular Phone

Work Email

Personal Email

Other…

Are you a current employee of FSU or an FSU contractor?

Yes

No

Are you a former employee of FSU or an FSU contractor?

Yes

No

Are you an applicant for a position with FSU or an FSU contractor?

Yes

No

Complaint Subject Information

Please provide information about the employee, individual, business or organization who is the subject of this complaint:

Subject 1 Information (click to expand):

Name

Address

City/Town

State/Province

ZIP/Postal Code

Relationship to the Institution

Other…

Phone Number

Subject 2 Information (click to expand):

Name

Address

City/Town

State/Province

ZIP/Postal Code

Relationship to the Institution

Other…

Phone Number

Subject 3 Information (click to expand):

Name

Address

City/Town

State/Province

ZIP/Postal Code

Relationship to the Institution

Other…

Phone Number

Additional Details

Complaint Information

Please provide a detailed explanation of the alleged violation/incident to include information about exactly what the subject/s of the complaint did that you believe is a violation of FSU policy, procedure, to include an act of fraud, waste, abuse, or other dishonest acts. The information you provide should be specific and include names, dates, policy violations, if known, and other relevant details.

How long has the violation/s been occurring?

Is the violation still occurring?

Yes

No

How did you become aware of this violation?

Please provide the names of any witnesses to the allegations and contact information, if known.

Has anyone else been notified about this complaint? If yes, who did you notify, when, and what was the outcome?

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Acknowledgement

By clicking the “Submit Complaint” button below, you are affirming the information contained in this complaint is true and correct to the best of your knowledge. Upon receipt of your complaint, the Office of Audit and Advisory Services (OAAS) will conduct a review of the information provided and additional information may be requested. OAAS will notify you about the determination as to whether our office will initiate an investigation or potentially refer your complaint to another entity for review.

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Complaint Intake Form

Complainant Information:

Complaint Subject Information

Additional Details

Complaint Information

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Office of AUDIT AND ADVISORY Services