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2013 .. 2014 .. 2015

Fraud, Waste or Abuse Report Form 

For more information about reporting fraud, waste or abuse, please click here.

Please provide name of the institution involved.  
 

In your own words, please describe the who, what, when, where and how of the fraud, waste or abuse.   
 

Please provide the names (s), job title(s), department(s) of the individuals involved. 

 
 

Please indicate the date/time the event occurred. 


 

Please describe how and when you became aware of the problem you are reporting. 

 
 

If you have reported your concern to any other department, school or agency, to whom did you report your concern?   
 

If you wish to remain anonymous, you do not have to provide contact information. We encourage you to provide your contact information for any follow-up questions that may arise during our review or to obtain a copy of the final report at the completion of the review. All contact information provided is considered confidential under TCA 8-50-116. However, if TBR or one of its institutions has a separate legal obligation to investigate the complaint (e.g., complaints of illegal harassment or discrimination), TBR and its institutions cannot guarantee anonymity or complete confidentiality.

Full Name  

Work Phone  

E-mail Address  

If there are other individuals aware of this problem who could provide information, please provide their full names and contact information.