ACAHM Complaint Form

ACAHM Complaint Form
For purposes of its Policy Governing Complaints, ACAHM defines a complaint as notification by any individual (emphasis added) person or entity (including, but not limited to, any individual student, faculty member, or staff member of an ACAHM-accredited school or program; any individual member of the general public; any representative of a state, federal, or local government; and any individual member of any institution or organization) that sets forth reasonable and credible information that (a) an ACAHM-accredited or pre-accredited school or program; or (b) an applicant seeking ACAHM accreditation is not in compliance with ACAHM’s Eligibility Requirements, Standards and Criteria for Accreditation, required accreditation policies/procedures and or its Code of Conduct and Professional Ethics.

ACAHM takes all complaints seriously. When processing complaints, ACAHM must apply its due process responsibilities and confidentiality obligations equally to complainants, and the institutions and programs it accredits. For these reasons ACAHM only accepts and processes complaints submitted by individual complainants, or by an authorized representative for and on behalf of a school, program, or other entity. This does not preclude complaint submissions by those with same or similar concerns or allegations however, each must complete, sign, and submit their own separate complaint.

Non-Retaliation. ACAHM and its accredited or pre-accredited institutions/programs are explicitly prohibited from retaliating against individuals or entities filing complaints with the Accreditation Commission for Acupuncture and Herbal Medicine (Commission). Such retaliation constitutes grounds for the Commission to take appropriate action including adverse action against the school or program.

FORMAL COMPLAINT SUBMISSION INSTRUCTIONS: Submit this completed and signed Complaint Form and any supporting documentation.

Alternatively, grievances can be submitted by mail to: 500 Lake Street, Ste. 204, Excelsior, MN 55331 or electronically to: info@acahm.org
Information about the party making the complaint (the “Complainant”)

Directions: Complete this form in its entirety and sign. Describe clearly and completely the specific nature of your complaint; upload supporting documentation where applicable; and identify what relationship you have to the institution or educational program at issue (i.e., student, faculty, staff, etc.) Submit this completed form and any supporting documentation.
Complainant's First Name*
Complainant's Last Name*
Email*
example@example.com
Contact Phone Number*
Please enter a valid phone number.
Correspondence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

This complaint is being made against:*

A program/school that is accredited/pre-accredited (Candidate) by ACAHM or is seeking ACAHM accreditationACAHM

Name of School*
State of School*
Complainant’s relationship to school/program*

Have all internal institutional/program grievance and review mechanisms available been exhausted?*

YesNo
If “Yes,” describe and include evidence of your efforts to resolve the complaint through the school or program’s internal grievance process or explain the reason(s) that such efforts would not be productive.*

This complaint is premature. Complainants must exhaust all institutional/program grievance and review mechanisms before complaints will be fully considered by ACAHM.*

Check to confirm acknowledgement

The Commission will evaluate complaints made against it, including those that relate to its monitoring of school/program’s compliance with ACAHM’s Eligibility Requirements, its Standards and Criteria for Accreditation, and the Commission's adherence to its accreditation policies and procedures, and its Code of Conduct and Professional Ethics Guide. Describe your comment or complaint against ACAHM in the box below. (Be specific – who, what, when, where, and how)*
Describe the allegations that may constitute a violation of one or more of ACAHM’s Eligibility Requirements, its Standards and Criteria for Accreditation, policies, procedures and/or its Code of Conduct and Professional Ethics Guide. Be specific. Attach supporting documentation, as needed.*
Supporting Documentation

Please name your supporting materials with meaningful names to assist reviewers.
Cancelof

Are there legal and/or administrative proceedings related to this complaint?*

YesNo
Please describe the nature of the legal and/or administrative proceedings, the forum, and the status to date*
Generally, ACAHM will not investigate anonymous complaints (i.e., complaints in which the identity of the complainant is not known). ACAHM, in its sole discretion, may require an institution or program to respond to such a complaint if the identity of the complainant is not necessary to determine whether the allegations constitute non-compliance with ACAHM’s Eligibility Requirements, Standards and Criteria for Accreditation, required accreditation policies/procedures and/or its Code of Conduct and Professional Ethics.
Please read the following carefully and check one (1) box. *

By checking this box, I request that ACAHM hold my identity in confidence regarding this complaint. I understand that my identity may be disclosed by ACAHM: (i) if necessary to afford a program/institution due process in responding to the complaint, and/or (ii) if required by law, including, but not limited to, a legally valid subpoena, regulatory inquiry, U.S. Department of Education regulations, or other legal processes. I understand that in those instances where my identity must be divulged to afford a program/institution due process, I will be requested to submit a written release of my identity and that unless I submit that release to the Commission in writing, this complaint may be dismissed. Additionally, while ACAHM will take every reasonable precaution to prevent the identity of the complainant from being revealed, ACAHM cannot guarantee the confidentiality of the complainant.By checking this box, I authorize ACAHM to divulge my identity as it deems necessary regarding resolution of this complaint.
Date

MonthDayYear
Date
Complainant's First Name Printed
Complainant's Last Name Printed
Complainant's Signature

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ACAHM Complaint Form

Information about the party making the complaint (the “Complainant”)