First Name:
Last Name:
Required
Email
Phone:
Required
Do you have lawyer, and do you prefer we communicate through your lawyer?
Yes
No
Required
What is your employment status and position, and who is your employer?
Required
What type of assistance are you seeking and what are your goals in working with our office?
Required
Describe and summarize the issue you want to disclose?
Required
Have you experienced any retaliation in connection to your whistleblowing, and/or are you concerned about future retaliation? Please describe.
Required
Have you filed your disclosure elsewhere yet? If so, where, and what is the status of any related investigation?
Required
If you have shared this information with another congressional office, can we contact that office?
Required
How did you obtain the information you are disclosing? Are there legal limitations around its release?
Required
How would we safely obtain supporting documentation?
Required
Do you have colleagues that can corroborate or support your disclosure?
Yes
No
Required
Does your disclosure have federal policy implications, require oversight or legislative action?
Yes
No
Unsure
Required
Are you a constituent of the Fourth Congressional District of Arizona?
Yes
No
Required
Are you willing to be contacted regarding this disclosure?
Yes
No