Your Information:

Question Title

* Your Information:

Are you employed by the State of South Carolina?

Question Title

* Are you employed by the State of South Carolina?

If so, what agency?

Question Title

* If so, what agency?

Name of person (s) and agency involved in alleged wrongful act or ommission

Question Title

* Name of person (s) and agency involved in alleged wrongful act or ommission

Summary of facts relevant to the allegations
Please describe the problem and who is involved. Please include when and where it happened.

Question Title

* Please describe the problem and who is involved. Please include when and where it happened.

Has the complaint been filed with any other agency or investigative entity?

Question Title

* Has the complaint been filed with any other agency or investigative entity?

If Yes, what is the name of the agency

Question Title

* If Yes, what is the name of the agency

Date Filed:

Question Title

* Date Filed:

Are there any documents regarding the alleged wrongful act or omission??(i.e., contracts, memos, letters, evaluation forms, minutes of meetings, etc.) If so, describe them.

Question Title

* Are there any documents regarding the alleged wrongful act or omission??(i.e., contracts, memos, letters, evaluation forms, minutes of meetings, etc.) If so, describe them.

Provide the name(s) of other people we may contact with knowledge of the alleged wrongful act or omission. Include the address and phone number of each person.

Question Title

* Provide the name(s) of other people we may contact with knowledge of the alleged wrongful act or omission. Include the address and phone number of each person.

T