Sophia School Corporation

Whistleblower Report / Consultation Sheet⮚ Unless the whistleblower gives his/her consent, the details of the report will be shared only with the minimum scopeof parties necessary to resolve the report, and all parties involved will be obligated to maintain confidentiality.
⮚ Before reporting, please be sure to understand the "Points to Note When Reporting" section on the "Whistleblowing
System" page of the university's official website (https://www.sophia-sc.jp/en/whistleblowing_e.html).
⮚ Please fill in the whisleblowing report to the best of your knowledge. (You do not need to fill out everything.)⮚ "Evidentiary materials, etc." is not limited to written documents but also includes electronic data and other items
that serve as evidence of the facts contained in the report. Please provide them fot the reporting office whenreporting.

YYYY / MM / DD

Date:

/

Purpose:/Whistleblower Reporting

Consultation

Personal Information
Anonymous Reporting?

YesNo(If "YES", you don't need to write your name below.)

NamePosition / Affiliation
The Corporation’s officers
Teaching / Administrative staff (Affiliation:)

Student (Affiliation / ID No. :)Retired staff (Affiliation at time of retirement:)

Workers dispatched under Contract [*1] (Affiliation:)

Employees of Business Partners [*2] (Affiliation:)

Others)([*1] workers dispatched under contract and workers who engage in business at Sophia School Corporation
based on a consignment contract or other contract with the Corporation[*2] employees of business partners based on contracts with the Corporation

Contact Information
Preferred contact method

Postal mailE-mailPhone(Multiple answers allowed)

Postal Address
E-mail address
Phone numberFor administrative purposes (Please don't fill in this box)
受信日：
受信方法：

受付番号：
電話

電子メール

郵送

面談

備考：

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(Please enter the details of your report below.)
Details of the whistleblowing report
The fact of any illegal act
Person to be reported

Has occurred

Is about to occur

Name
Affiliation

Contents of the facts to be reported (When, Where, Who, What, Why, and How?)*Please be specific.

*If you can't write all the lines, you can change the line height or add more lines. You may also fill out a separate sheet of paper and attach it.

When and how you knew about the facts to be reported

Thoughts on the facts to be reported (possible violation of laws and regulations, or university rules)

Do you want corrective measures?
Yes(*We do not guarantee that the measures you request will be implemented.)No

If "Yes", please indicate the measures you would like to take.
()Special Remarks

Evidentiary materials, etc.
I have (Attached

Submission at a later date)

I don't have

Do you want to be notified of the results of the investigation?
Yes

No(* Anonymous reports will not be contacted.)

Did you report or consult with anyone other than this report?
I reported/consulted

I reported/consulted, but not corrected

I was disadvantaged as a result of reporting or consulting.

I did not report/consult yet

Where to report/consult (name, organization name, etc.) and when the report was madePlease fill out the necessary information and submit it to the reporting office.
Sophia School Corporation Audit Office
7-1 Kioi-cho, Chiyoda-ku, Tokyo, 102-8554
E-mail: koekitsuho110-co@sophia.ac.jp
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