Confidential Complaint Form

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This questionnaire is a part of the reporting framework related to HOPE's Whistleblowing & Confidential Reporting Guidelines. This questionnaire can be used by any / all complainants; it can be used by someone on behalf of a complainant; it can be used by any HOPE staff or staff of HOPE's partners; or it can be used to guide any in-person or telephone-based complaints, to ensure a consistent set of information is always collected.

Please note: This form does not record your email address, and therefore, it can be submitted anonymously.

Importantly, responses can only be made online using this English version. But the numbered questions on both language versions are the same; hence, you can read the translation and answer the same numbered question in the English form. The English version is here:www.hope-international.com/complaints

Alternatively, you can also write your responses on any language version of the form, and send by mail, attention to:

Sean Burke *CONFIDENTIAL*, Director for Overseas Programs, 410 - 713 Columbia Street, New Westminster, BC. V3M 1B2, Canada

The purpose of this form is to provide a confidential and anonymous form for employees, contractors, volunteers, and any other stakeholders of HOPE International Development Agency programs to report suspected wrongdoing or risks of harm within the organization's direct or associated operations or activities, without fear of retaliation in any form, including victimization, discrimination, disadvantage or dismissal.

HOPE encourages all employees, contractors, volunteers, and all other stakeholders to raise concerns within the organization, rather than ignoring a problem or feeling a public complaint is their only option.

1. What is the general topic of this complaint? *

Misuse of funds (this may not be fraud; but still be inappropriate)

Fraud (anyone not being truthful to gain an unfair advantage, including financial, or to harm another person's rights or interests)

Corruption (someone in a position of power who misuses that power to gain personal benefits or advantage unfairly.)

Sexual Exploitation (someone in a position of power who misuses or attempts to misuse that power for sexual purposes)

Sexual Abuse (anything of actual or threatened sexual nature, whether by force or under unequal or coercive conditions)

Other Abuse or Harassment (manipulation of power, inflicting harm, failing to act to prevent harm, or distressing, humiliating, or threatening behaviour)

Other Breach of HOPE Policy or Code of Conduct

Any other wrongdoing or unethical behaviour

2. Name the country where the topic of this complaint occurred. *

3. What Year and Month did the topic of this complaint occur? *

4. Name the organization, person or persons you are making the complaint against. *

5. What is the role of the person you are making the complaint against? *

Staff member of HOPE

Staff member of HOPE Partner organization

Community Volunteer

International Volunteer

Donor

Not sure

You are making a complaint against the organization (rather than indivdiuals)

Other:

6. Name the person or persons who have been impacted by the topic of this complaint (optional)

7. What is the age (or estimated age) of the person or persons who have been impacted by the topic of this complaint? *

18 years or older

Less than 18 years

Not sure

Other:

8. If you do not know the names or are uncomfortable stating the names, provide as much information as possible to describe the person or persons who have been impacted by this complaint. (where they live, what is their sex/gender, are they a staff member or community member, information about the employer or community, any other information) *

9. Provide a detailed description of what occurred / what your complaint is about. (who did what, when did it occur, how did it occur, where did it occur, why did it occur, has it happened more than once, etc) *

10. List anyone you have already reported this to and when you reported it. (optional)

11. Are you reporting this complaint on behalf of someone else? *

Yes (this did not happen to me - please answer q12)

No (I am the person affected - go forward to q13)

12. If you answered yes to question 11, did the affected person/s give their permission for you to submit this complaint? Even if they did not, please continue to complete this form.

Yes

I did not ask them

Other:

Clear selection

13. Are you a staff member of an implementing partner of HOPE / or HOPE? *

Yes

Prefer not to answer

14. Is this complaint from a whistleblower or someone who is concerned about retaliation for making the complaint? *

Yes

15. What is the name of your organization? (optional)

16. Do you fit in any of the following categories? *

You are the victim or survivor of the topic of this complaint

You are a family member of the victim or survivor of the topic of this complaint

You are a community volunteer

You are a community member

You want to be anonymous (this is your final question on this form)

None of these apply to me

Other:

Required

17. What is your name? (optional)

18. What is your phone number? (optional)

19. What is your email address? (optional)

20. What is your home address? (optional)

Thank you for providing this important information to HOPE!

HOPE fosters a culture of openness, integrity, and accountability to ensure protection for individuals who report allegations of misconduct from retaliation, harassment, or victimization. We commit to acting promptly and fairly in investigating all reports of misconduct as well as upholding the confidentiality of reports to the fullest extent possible unless required by law to disclose specific information. If you have any further questions or you would like to speak to someone at HOPE to anonymously ask questions about this report, or provide additional information, please call +1 (866) 525-4673 extension 132 or 122 to leave a message with Jon or Sean respectively. Jon is the Executive Director (interim) and Sean is the Director for Overseas Programs. Jon and Sean are responsible for responding to these reports. They can also be contacted at jonm@hope-international.com or seanb@hope-international.com.

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