Whistleblower Policy and Reporting Form

Do you wish to remain anonymous?*

YesNo
Name:*

First NameLast Name
Email:*
Phone:*
Please enter a valid phone number.
Best time to communicate with you:*
I am filing this report as a:*

StudentFaculty/Instructor/CoachStaffAlumnus/AlumnaBoard of Trustees MemberOther concerned individual
What is the concern about?*
Who is the concern about (check all that apply)?*

Senior Administrative Staff (Cabinet Members)SupervisorFacultyStaffBoard of TrusteesStudentDepartment or OfficeContractor or VendorOther/Unknown
Date of event causing concern (MM/DD/YYYY, no specific date, or unknown):*
Please describe the details of the event or circumstances of your concern including the locations of witnesses and any other information that could be valuable in the evaluation and ultimate resolution of this situation. Note: Please take your time and provide as much detail as possible, but exercise care to not provide details that may reveal your identity unless you wish to do so.*
Please indicate the name of the person or persons about which you are filing this report:*
How long do you think this matter has been going on?*
How did you become aware of this matter?*
Is management aware of this matter?*

YesNoDo not know/do not wish to disclose
Please identify any persons (names and titles) who have attempted to conceal this matter and the steps they took to conceal it (examples: ignored it, changed documents, said it was not a problem, said they would look into it):*
Signature:*

I believe the information above to be true and accurate.
Signature Value
Date:*

MonthDayYear
Sender name
Sender email
By submitting this report, I certify that the information provided is true and accurate to the best of my knowledge. I certify that I am acting in good faith and have reasonable grounds for believing that the information disclosed indicates a potential violation. I understand that Aurora University forbids retaliation in any manner against individuals who, acting in good faith, report a known or suspected violation, assist in making a report, cooperate in an investigation, or otherwise exercise their rights or responsibilities under the Whistleblower Policy.

To submit supporting documentation please do so by emailing whistleblower@aurora.edu.
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