American Association of Grant Professionals s1

Grant Professionals Association Code of Ethics Violation Reporting Form

Any individual or agency, whether or not they hold a GPA membership, may complete this form to lodge a complaint about a GPA member’s possible violation of the GPA Code of Ethics.

Please note: The complainant’s identifying information will be kept confidential and will be used only to track complaints and to ask for more information about the alleged offense if needed. Members of the GPA Board of Directors and/or Ethics Committee may be informed of the complainant’s identity in the process of investigating the complaint.

This form can be completed in Microsoft Word by clicking on and typing in the grey boxes next to each field. Please complete, sign and mail to the address indicated on page two. Every complaint is examined and a resolution is recommended to the GPA Board of Directors.

PART I: ALLEGED COMPLAINT Complainant (person filing the complaint): Name: Daytime Phone #: Evening Phone #: Address: City, State, Zip:

GPA Member: Yes No Chapter Affiliation: Yes No GPA Membership Number Which Chapter?

Complainant’s Relationship to Respondent (e.g., Supervisor, co-worker, fellow GPA member):

Respondent: (Person against whom the complaint is filed) Fill out as much as you can. Name: Daytime Phone #: Evening Phone #: Address: City, State, Zip: GPA Member: Yes No

Chapter Affiliation: Yes No

Which Chapter?

Board Approved 11/07, Revised 9/16 Grant Professionals Association Code of Ethics Violation Reporting Form

Complaint (to be filled out by complainant): Please describe the circumstances of the complaint: Please identify the standard(s) in the GPA Code of Ethics that you believe has been violated: Supporting Evidence Attached: Yes No If yes, list attachments:

Certification: I certify that this information is true and correct to the best of my knowledge, and that I am making this complaint in good faith without malice.

Signature: Date:

Please return this complaint form by mail or email to: Grant Professionals Association CEO 10881 Lowell Avenue, Suite 190 Overland Park, KS 66210 (913) 788-3000 Phone (913) 788-3398 Fax Email: [email protected]

If you email the form, please also print a copy and sign, then forward to GPA by mail or fax so your original signature is on file. This complaint will be reviewed by GPA within 30 days of receipt.

PART II: RESPONSE TO COMPLAINT You must complete this form in response to the complaint filed against you with GPA. You have 30 calendar days from receipt of notification of the complaint by Certified Mail to submit this response.

Respondent: Name: Daytime Phone #: Evening Phone #: Address: City, State, Zip:

GPA Member: Yes No Chapter Affiliation: Yes No GPA Membership Number Which Chapter? Response to Complaint: In your own words, please respond to the complaint filed with GPA:

Supporting Evidence Attached: Yes No If yes, list attachments: Certification: I certify that the information contained in this response is true and correct to the best of my knowledge.

Signature: Date: Please return this complaint form by mail or email to: Grant Professionals Association CEO 10881 Lowell Avenue, Suite 190 Overland Park, KS 66210 (913) 788-3398 Fax Email: [email protected]

If you email the form, please also print a copy and sign, then forward to GPA by mail or fax so your original signature is on file. This complaint will be reviewed by GPA within 30 days of receipt.

PART III: GPA INVESTIGATION AND RESPONSE (For Official Use Only) This part of the process will be completed within 30 days of GPA’s receipt of the respondent’s reply to the allegations. If the committee requests additional information, the timeline could be extended. Both parties will be notified if the timeline is extended.

Initial Response: Complaint #: Date Complaint received: Date Respondent Notified: Date response received from Respondent: Attached? Yes No Standard(s) of Professional Practice Allegedly Violated (List #s): Date packet forwarded to Ethics Committee Chair/Grievance Committee: Ethics Committee Chair (name): Ethics Committee Board Liaison (name): Ethics Committee Members examining the case: CEO’s Comments:

Ethics Committee Response: Date initially reviewed by Ethics Committee: Recommended for: Examination Dismissal Comments: Examination Held: Yes No If yes, date of meeting: Outcome of Examination:

Disposition of Complaint: Check the appropriate disposition: Complaint is unfounded, no action taken Complaint is founded, examination held, no sanctions imposed Complaint is founded, examination held, sanctions imposed

Sanctions Imposed: Page 4 of 7

Private reprimand in writing Consequences within GPA while maintaining membership List Consequences: Temporary revocation of membership Until (date): Who was notified beyond respondent?: Permanent revocation of membership with notification through members only communications Referred to GPCI for investigation Other sanctions: Describe:

Date respondent notified of disposition: Note: Attach copy of letter Complainant notified of disposition, if necessary: Yes No If yes, Date: Additional Comments:

Certification of Examination: I certify that the examination and disposition of this complaint was complete, thorough and carried out in good faith and without malice.

______Signature, CEO Date

______Signature, Ethics Committee Chair Date

PART IV: APPEAL This form should be completed by a respondent who wishes to appeal the disposition of their complaint. The respondent has 30 days from the date of notification about the outcome of the examination process to file an appeal.

Respondent: Name:

Reason for Appeal:

Reason for disagreement with complaint disposition:

Supporting Evidence Attached: Yes No If yes, list attachments:

Certification: I certify that the information contained in this appeal is true and correct to the best of my knowledge.

Signature: Date:

Your appeal will be forwarded to the GPA Board of Directors for review. You will be notified of the outcome. All decisions made by the Board of Directors are final.

PART V: RESPONSE TO APPEAL The GPA Board of Directors has 30 days from the date of notification about the appeal to issue a decision.

Board of Directors Response:

Outcome of Appeal:

Appeal denied, original decision stands

Appeal granted, sanctions altered

Note changes in sanctions:

Appeal granted, complaint dismissed

Date Outcome Determined:

The disposition of this complaint as indicated on this form is now complete and final.

______Signature: CEO Date

Board Approved 11/07, Revised 9/16