MARCO Grievance Form

Grievances will be handled in accordance with MARCO's Grievance Procedure. Please review the Grievance 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 a MARCO Certified RCO, please use this form.

Your Name*

First NameLast Name

Your Email*

example@example.com

Your Phone Number*

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 explain the nature of the grievance, including detailed information and evidence of the issue, witnesses, related policies, etc., and the remedy or outcome desired:*

Supporting documentation

Please upload any files or documents that provide further evidence of the grievance you are filing.

Have you previously attempted to resolve this grievance with someone at MARCO?*

Please provide additional information.*

What steps did you take to address the issue with the intended party? What response did you receive? Provide any other relevant information that could be helpful for our investigation.

Does this grievance involve MARCO's Executive Director?

Grievances pertaining to the Executive Director will be sent to MARCO's Board President.

Acknowledgement:

In filing this grievance, I understand that it may be necessary for MARCO to disclose information in connection with this grievance to facilitate a resolution. For this reason, MARCO can make no warranty that it will protect the source of this information. However, MARCO will endeavor to keep information concerning the grievance confidential. The Report Recipient and other members of the organization who investigate a grievance will discuss it only with those individuals who have a need to know about it or who are needed to supply necessary background information or advice. 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.*