Name

Contact Information:

Street:

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Telephone:           

Home:    Cell:         

Email: 

Blew the whistle against which government agency?

Agency: 

Brief description of your whistleblowing activity (e.g. dates, nature of whistleblowing) and any retaliation or other unfavorable treatment that came as a result of your disclosures.

All applicants must accept the following  NSWBC - General Agreement. 

NSWBC-General Agreement   NSWBC shall remain completely Non-Partisan. While members have their own political outlooks, views, activities, and parties of choice, our focus must remain on the issues concerning national security whistleblowers. Therefore, inappropriate personal views will not be expressed or voiced during activities carried out by NSWBC (Congressional meetings, Press Conferences, Group Meetings & Forums, etc.).  Members shall refrain from using the NSWBC umbrella to further their own cases. While each individual member has his or her congressional relationship and activities related to his or her case, issue, activity; a member cannot pursue his or her personal case/activity/issue with the Congress, by using the NSWBC name or on behalf of NSWBC.  One designated person shall review and approve official contacts with the media that are solely regarding NSWBC matters. While we may issue ‘Action Alerts,’ ‘Fax Campaigns,’ ‘Petitions’ for a certain cause/event/issue and ask members to sign, call, and/or contact a target congressional office or target media outlet, all networking and communication with Congress, other organizations, the media, and other members will be carried out centrally, through NSWBC officers or spokespersons).   NSWBC will set macro-level objectives and create mission statements. These objectives are dynamic and may expand and evolve, but changes to policy and goals will be implemented only after all members have been notified and after there is general discussion and agreement on new or expanded objectives.   NSWBC will currently include only whistleblowers from Federal government agencies dealing with intelligence, law enforcement, and nuclear energy; those from these agencies who have come forward on issues that deal with government waste, fraud, abuse, and criminal activities that have or will have national security and safety implications.  Those who have come forward on issues mentioned above after they have left the agency in question or after they have retired will be considered.  U.S. Intelligence/Security is our basis. Since NSWBC is focused on the particular issues mentioned above, and as its name suggests, at this time NSWBC is unable to accept and represent other types of federal government whistleblowers.   While NSWBC will try to help its members by providing contact information for press, legal entities, and other government watchdog organizations on issues related to each individual’s case, this is not NSWBC’s primary purpose.  A more formalized organization may occur as needed. As this coalition expands, members become familiar with each other, and others volunteer to take on some of these tasks and spend the necessary time fulfilling some of this work, NSWBC will create several positions for these individuals and their positions will be listed.  NSWBC will keep contact information of its members confidential. If a member decides to share his or her contact information with others, NSWBC will not be responsible for any resulting consequences. NSWBC will forward any press or congressional request for a specific member directly to him/her, and let the member decide what to do with that request.  By accepting below, I signify my agreement with the foregoing common rules/objectives set forth in this NSWBC-General Agreement. I agree to respect and honor all provisions of this general agreement. I acknowledge that by becoming a member of this coalition and by participating in any of its activities, I do so in a completely voluntary manner on my part, and that either I or NSWBC may withdraw from this mutual agreement and coalition with each other at any time, for any reason without recourse or liability on either party.

I Accept:      Yes       No