RCO Grievance Form

RCO Grievance Form

File a grievance related to a MARCO Certified Recovery Community Organization
Grievances will be handled in accordance with MARCO's Grievance Policy and Procedure for Certified RCOs. Please review the Grievance Policy and Procedure, which provides detailed information about how the process works. By submitting this form, you acknowledge that you understand the grievance process.

If you have a grievance related to MARCO, please use this form.
Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Your Relationship to Organization*
For example: employee, volunteer, contractor, peer recovery support services participant, program participant, etc.)
Organization Name (MARCO-certified RCO against whom the grievance is being filed)*
Only MARCO-certified RCOs are listed. If the organization is not in the drop-down menu, it is not certified by MARCO. Please select "Other" if the organization is not in this list.
If you selected "Other," what is the name of the organization against whom the grievance is being filed?*
MARCO will attempt to forward your grievance to the appropriate party. MARCO has no authority with RCOs that are not MARCO-certified.
Organization Website*
What is the website address for this organization?
Organization Primary Contact*
What is the name of the primary contact at this organization?
Primary Contact Email (email address at which we can reach the primary contact)*
example@example.com
Primary Contact Phone (phone number at which we can reach the primary contact)
Please enter a valid phone number.
Can you claim direct, first-person knowledge of the grievance you are filing?*
If you do not have first-hand knowledge of the grievance, please encourage anyone directly affected or involved to complete this form.
Please provide a detailed narrative explaining the nature of the grievance:*
Supporting documentation

Please upload any files or documents that provide further evidence of the grievance you are filing.
Cancelof
Have you previously filed this grievance with the RCO?*
Please provide additional information.*
What steps did you take to file the grievance with the RCO? What response did you receive? Provide any other relevant information that could be helpful for our investigation.
Acknowledgement:

In filing this grievance, I understand that it may be necessary for the Minnesota Alliance of Recovery Community Organizations (MARCO) to disclose information pursuant to this grievance to the subject RCO as well as to external agencies, including but not limited to the MN Department of Human Services Behavioral Health Division, the Minnesota Certification Board, the Office of the Minnesota Attorney General, or others. For this reason, MARCO can make no warranty that it will protect the source of this information. However, an attempt is made to withhold disclosure of the source to the extent that is reasonably possible. I authorize unrestricted use of the information filed in this grievance by the Minnesota Alliance of Recovery Community Organizations to act as it deems prudent and necessary. Please do not include any personal identifying information or protected health information about any individual.
I certify that the above information is entirely accurate to the best of my knowledge.*

Powered by Jotform SignClear
Should be Empty: