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Complaint Intake Form
Complainant Information:
First Name:
First
Last Name:
Last
Your Work Email Address:
Your Personal Email Address:
Address
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Cell Phone:
Home Phone:
Work Phone:
Employer:
Employer Address
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Relationship to the Institution
Other…
Phone Number
Subject 2 Information (click to expand):
Name
Address
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Relationship to the Institution
Other…
Phone Number
Subject 3 Information (click to expand):
Name
Address
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Relationship to the Institution
Other…
Phone Number
Additional Details
Where did this violation/incident occur?
When did this violation/incident occur?
Is there a supervisor or a member of management involved?
Yes
No
Other...
Other…
Enter other…
Is management aware of the problem?
Yes
No
Other...
Other…
Enter other…
If yes, who?
Has anyone attempted to conceal the violation/incident?
Yes
No
Other...
Other…
Enter other…
If yes, who? How?
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.
Complaint Information 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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