Conflict Resolution Intake Form
This form and any accompanying documents contain information belonging to the sender which may be kept confidential. This data is only for the use of the individual(s) involved and the entity to which it was intended.
Soror Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
What is your preferred method of contact?
Please Select
Phone
Email
Chapter Affiliation/Cluster
*
Current Office Held (If applicable)
*
Date of first occurrence (if applicable)
-
Month
-
Day
Year
Date
Is this the first time you have raised this concern, if so please explain below
Yes
No
How long has this been a problem in the chapter?
Witness Information (If applicable)
Please describe the situation
*
Why do you deem the matter adverse?
*
What steps have been taken to resolve the issue?
Date
*
-
Month
-
Day
Year
Date
Upload Supporting Documents (If applicable)
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Soror Signature
*
This form and any accompanying documents contain information belonging to the sender which may be kept confidential. This data is only for the use of the individual(s) and the entity to which it was intended.
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