Online Intake Application

DISCLAIMER:

Submitting an application to Government Accountability Project or communicating with us about
your application does not mean that Government Accountability Project is representing you.
Indeed, Government Accountability Project lawyers are not representing you unless and until
you receive written notification and have signed a retainer agreement. Until such point, your
application is under consideration, and if we request more information or documents from you,
this is only a part of the application process.

Please be advised that Government Accountability Project cannot guarantee prompt review or a
decision regarding your intake application. You should educate yourself about the deadlines
and/or statute of limitations associated with your case. Government Accountability Project is not
responsible for alerting you to such limitation periods during the application process.

Do not include any classified information in your application. If your case involves
classified information, please indicate that it does without revealing the information.

In addition, we strongly suggest that you complete this application from a personal, non-work
computer.
A completed form will allow us to properly review your potential case and make a
determination as to whether or not we might be able to help.

Please answer the following
questions to allow us to adequately assess your case. Forms not completed in full may
not be reviewed.
Are you currently represented by an attorney in connection with any aspect of this matter?
Contact 1
Where did you hear about Government Accountability Project?
What type of assistance are you seeking from Government Accountability Project?
Are You:
Employment status:
Are you or were you an employee of a federal contractor or grantee?
Employment Details
(for instance, Investigator)
(for instance, GS-9)
(If outside United States)
Are you covered by a collective bargaining agreement?
Which of the following apply to your employment status?
Excepted Service
Which of the following apply to your employment status?
Which of the following apply to your employment status?
Other
Which of the following apply to your employment status?
more items
Please provide the information requested below, to the best of your ability, for your
most recent position and any other position that you have held that is relevant to the misconduct
you observed.
Re-order Name of Organization for which you work Your Title Start Date of Employment End Date of Employment Brief Description of your Responsibilities Weight Operations
(If Applicable)
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Disclosure Section
Re-order Please identify the type of wrongdoing that you have disclosed. What did you Disclose? To whom, within your organization, did you make your disclosure/ How did you learn of the information you disclosed? Did individuals in your organization, other than those to whom you disclosed the information, learn about your disclosure(s)? If Yes, Who learned of your disclosure(s) and How did they learn about your disclosure(s)? What action (if any) did the organization take in response to your disclosure? Weight Operations
You may enter multiple people within your organization, disclosures made outside of your organization are addressed further below.
Did individuals in your organization, other than those to whom you disclosed the information, learn about your disclosure(s)?
(for example, did the organization investigate or otherwise look into what you disclosed or was disciplinary action taken against responsible parties?)
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If you check "violation of law, rule, or regulation" specify, if you can, the particular law, rule or regulation violated (by name, subject, and/or legal citation). If you have made multiple disclosures, please provide the information below for each disclosure by choosing “add another disclosure” at the bottom of the section.
Do you believe you have suffered retaliation because of your disclosure(s)?
What action do you believe was taken, not taken, or threatened because of your disclosure(s)
 Please provide Date, Name and Title along with additional comments.
For example, were comments
made that suggest that individuals at the organization were angry because of your
disclosure or did you notice changes in your relationships following your disclosure?
For example, did they suffer adverse consequences or embarrassment because of your
disclosure?
Re-order First Name Last Name Title Chain of Command Weight Operations
e.g. Deputy Director
e.g. 1st Level Supervisor
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HAVE YOU REPORTED THIS MATTER ELSEWHERE?
Have you sought assistance outside of your workplace prior to contacting Government
Accountability Project and/or shared the information you have disclosed with anyone not
noted in question [FILL IN AFTER NUMBERING COMPLETED] above ? (e.g., other
attorneys, a union representative, another non-profit organization, an elected official’s
office, an oversight agency, the media etc.)
Please indicate with whom you have shared this information, when you shared it, and what response you received, if any.
Re-order Name of Senator or Representative and, if applicable, staff person you communicated with Date Reported Weight Operations
Re-order To which agency IG did you report? Date Reported Status/Response Weight Operations
Re-order Date Reported Status/Response Weight Operations
Re-order Date Reported Status/Response Which State Weight Operations
Re-order Please specify the organization, the individual(s) with whom you have communicated, the date you contacted them, and what response you received, if any. Weight Operations
Re-order Please indicate to whom you reported and what response you received, if any. Date Reported Weight Operations
Have you filed any claims, taken any action to appeal or grieve this matter, or been involved in any legal proceedings in connection with the underlying misconduct or related retaliation?
Re-order Type of Action Date Filed Status Outcome (If concluded) Claims asserted (if applicable) Court name (if applicable) Weight Operations
Type of Action
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Add as many rows as applicable.
Interested in Disclosure Section
Please identify the type of wrongdoing you are interested in disclosing
Check ALL
that apply. If you check violation of law, rule, or regulation, specify, if
you can, the particular law, rule or regulation violated (by name, subject, and/or legal
citation.
Re-order First Name Last Name Title Weight Operations
more items
Have you sought assistance outside of your workplace prior to contacting Government Accountability Project?
What are your goals in this matter? (Check all that apply.)
In addition, are you able to pay the expenses associated with litigation, such as depositions, print materials or travel expenses, if necessary?
Thank you for your submission. Our legal team carefully reviews all submissions. It may take up
to one month for us to review your application. If you do not hear from us within a month, please
call us at 202.457.0034. As a reminder, you are responsible for understanding the deadlines
associated with your case, and Government Accountability Project is not responsible for alerting
you that a deadline is approaching during the application process.
For further information about whistleblowing, please visit our Resources page.
Case
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