Research Fund Misappropriation Report

(for e-mail/postal submission)

■ Reporter Information

Name		Date of birth
Phone number		Mobile phone
e-mail
Address

■ Report details

Title*
Accused*	Ex) Hong Gil-dong, Administrations Department, XX Institution. Please list all relevant parties, if there are multiple.
Time*	Ex) At around 15:00 on Jan 1, 2021; about a week ago; about a month ago; since about a year ago, etc.
Place*	If the location is difficult to specify, describe the primary location the event took place or the process was involved in.
Details*	Please describe every little detail regarding the matter being reported as each item will be of great help to the process of inspection and its processing. However, do not include any circumstances that may reveal the reporter’s identity.
Witness	Please list any person who is aware of the issue or is likely to be aware.
Verification method	Please state the method that you believe is best for us to verify the content of this report. Ex) Cross-checking Ledger A with Ledger B; Verify CCTV footage and vouchers of a certain date, Fact-check with Manager A and Assistant B, etc.
Manner of discovery*	Ex) The incident involves me; I directly saw what hapepned or heard, I accidentally read a document, etc.
Duration*	Ex) Once; a week; one to three months; three months to a year; more than a year, etc.
Evidence	If you have supporting evidence, please list the title and attach.

※ Items marked with (*) are mandatory fields.

※ If you are reporting under your real name, please complete and submit the Personal Information Collection and Use Consent Form provided in the [Attachment].

Personal/Identification Information Collection and Use Consent Form

1. On the collection and use of your personal Information

We, the Research Fund Misappropriation Report Center of the Industry-Academic Cooperation Foundation of Jeju National University, collect your personal information to receive, verify, and process research fund misappropriation reports.

You can submit a report by providing the required information for processing and agreeing to the collection and use of your personal information.

The information collected will be protected in accordance with the 「Personal Information Protection Act」 of the Republic of Korea, and will not be used for any purpose other than processing the report.

Items collected: Name, date of birth, phone number, e-mail, and address

The personal information collected for report processing will be retained for a period of time in accordance with relevant laws and regulations.

We inform you that you have the right to refuse consent to the collection and use of your personal information; however, such refusal may delay the progress of the inspection.

□ I agree to the collection and use of my personal information.

2. On the collection of your identification information

We, the Research Fund Misappropriation Report Center of the Industry-Academic Cooperation Foundation of Jeju National University collects your identification information (Resident Registration Number) to receive, verify, and process research fund misappropriation reports.

You can submit a report by providing your identification information required for processing and agreeing to the collection and use of your personal information.

The identification information collected will not be used for any purpose other than processing the report.

The identification information collected for report processing will be retained for a period of time in accordance with relevant laws and regulations.

We inform you that you have the right to refuse consent to the collection and use of your identification information; however, such refusal may delay the progress of the inspection.

□ I agree to the collection and use of my identification information.

Date: ______________

Name:            (Signature)                  Submission to: Director of Industry-Academic Cooperation Foundation of Jeju National University