COMPLAINT SUBMISSION FORM

COMPLAINT SUBMISSION FORM

Formal Resolution
This form is for submitting a complaint for formal resolution to Basketball WA. Only matters that relate to, or which occurred at, WABL, NBL1, State Level, as well as serious cases referred from an Association will be dealt with by Basketball WA.

Complaints that relate to competitions or personnel under the Asssociation must be referred to the Association. This form should only be submitted after a person has attempted to resole their complaint; or where informal resolution is not possible or appropriate.

This form will be submitted to the Association Development Team who will be in contact with you as soon as possible.
Contact Information
Name:*

First NameLast Name
Title:*
Organisation e.g., Club or Association*
Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com
Are you submitting this complaint on behalf of someone else? If you are submitting a complaint on behalf of someone else, please provide their contact details below;
Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Email:
example@example.com
Witness Information (if applicable):

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Please select what category your complaint is regarding:*
Other (please specify):
Location of alleged breach:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of alleged breach:*

MonthDayYear
Date
Please detail what your complaint is:*
File Upload

Cancelof
What outcome are you seeking?*
Other (please specify):
Complainant Declaration
In submitting this complaint, I confirm that:*

The information I have provided on this form is correct to the best of my knowledge;I intend to cooperate in good faith, act in accordance with the BWA Code of Ethics and Code of Conduct, respect confidentiality of the process and immediately disclose any actual, perceived or potential conflict of interest to the Responsible Officer for the complaint as part of my involvement in the complaint process; andI understand that the information I provide will be treated confidentially and will not be disclosed to a third party unless required.
Signature

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COMPLAINT SUBMISSION FORM

Contact Information

Complainant Declaration