Confidential Complaint Form

Please complete all applicable sections.
1. Department where the suspected improper activity occurred.
2. Name of individual(s) involved in the improper activity.
3. Describe the potential improper activity in detail (include dates, time, witnesses, etc).
4. When did you discover or become aware of the improper activity?
5. How long has the improper activity been going on?
6. List the names of individuals who may be able to help in an investigation.
7. Reference or provide any records that can assist with an investigation.
8. Do you wish to remain anonymous?

If no, please provide your contact information (name, phone number or email) and the best time to contact you.
Andrews University is a Seventh-day Adventist institution of higher education
Phone: 1-800-253-2874   E-mail:
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Berrien Springs, Michigan 49104