Whistleblower Report Form

You'll have a better experience on this website using a secure, up-to-date browser. Click here for information and instructions about updating.

A whistleblower can be any employee, student, vendor, guest, alumnus/alumna, or supporter of the university who has direct knowledge, or a reasonable concern, that the university or any of its agents is acting contrary to any applicable federal, state or local laws or contrary to an established Dordt University policy. Whistleblowers are encouraged to report the activity and may do so without fear of reprisal or retaliation. The policy and process are under the supervision of the Vice President for University Operations.

The whistleblower must initiate the process as defined on the University’s external website or the intranet website. The relevant links are included in the “Report It” section. The adjudicator of the report will inform the reporting individual upon receipt of the report and at the conclusion of the investigation. The investigation shall normally be completed within 60 days.

If you selected your supervisor above, this matter will be moved up to a level above your supervisor to ensure confidentiality.
Include Name and Phone Number of each.

I certify the aforementioned information which I marked or filled in on the pages above of this form is true and correct. I also verify that I understand that I may be asked for more information and an investigation may take place.

Type your name to sign.