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Misuse of Funds/Misconduct Form

  1. Jackson County COMBAT

  2. IMPORTANT

    To submit this form you do not have to sign or create a Form Center account above. However, you will have to complete the form in its entirety without the option to save your progress unless you do create an account.

  3. Misuse of Funds / Misconduct Form

    This form was created so that the misuse of COMBAT funding by outside agencies and/or Jackson County Departments could be reported to the COMBAT administration. Other forms of alleged misconduct by COMBAT-funded agencies can also be reported using this form.

    If preferred, reports can be filed by calling 816-881-4337.

    REPORTS CAN BE SUBMITTED ANONYMOUSLY

  4. WHO

  5. County Department Or Agency*

    Are you reporting the misuse of funds or misconduct by a outside agency or Jackson County receiving COMBAT-funding?

  6. Identify the County Department involved in the alleged misuse of COMBAT funds.

  7. List any individuals in the department directly involved in the alleged misuse of COMBAT funds.

  8. Identify the agencey involved in the alleged misuse of funds and/or miscondcut.

  9. List any individuals directly involved in the alleged misuse of funds and/or misconduct.

  10. WHAT

  11. Provide details of the alleged fraud, waste, misconduct, etc. Include any informatin you believe may be relevant.

  12. Are you aware of any attempts to hide the misconduct?*

  13. WHEN

  14. Is the misconduct/misuse ongoing?*

  15. OTHER

  16. List or describe any documents or other evidence you or others may have that is relevant to the alleged misconduct/misuse of funding.

  17. List names and contact information for other witnesses who can corroborate allegation and/or provide additonal information.

  18. YOUR INFORMATION

  19. Remain Anonymous

    I understand that this means COMBAT staff will not be able to contact me if additional information is needed from me, nor will I be able to request the status of the report I am submitting.

  20. Remain Confidential

    You may contact me for additonal information, but please keep my name confidential and do not share it outside the COMBAT or Jackson County Prosecutor's Office.

  21. Confidentiality/Anonymity Waived

    You may contact me for additional information, and I do not place any restrictions on the use of my name.

  22. Leave This Blank:

  23. This field is not part of the form submission.