REPORTER'S CONTACT INFORMATION (Not Required)

SUSPECT'S INFORMATION

WITNESS(ES) | Please provide witnesses that can confirm your allegations

COMPLAINT

Briefly describe the improper activity and how you know about it. Specify what, who, when, where and how. If there is more than one allegation, number each allegation. Use as many pages as necessary.

• What wrongdoing occurred?
• Who did the wrongdoing?
• When did this occur?
• Where did this happen?
• What enabled this to happen?

EVIDENCE

Please describe how an OLGCHS investigator could locate supporting documentation or attach a copy of evidence that you already have in your possession. You should NOT ATTEMPT TO OBTAIN evidence for which you do not have a right of access.

Please provide an email address where we can send a link to your current form.

Email Address :