Southeastern Virginia Homeless Coalition Participant Grievance Form

Southeastern Virginia Homeless Coalition Participant Grievance Form
The SVHC Continuum of Care is the governing body for homeless assistance programs in the cities of Norfolk, Chesapeake, Suffolk, Franklin, and the counties of Isle of Wight and Southhampton.

This notice is to inform you that you have the right to express any grievance you may have with either the program staff or activities where you are being served AND/OR with the SVHC Process including the Coordinated Entry System through a formal grievance procedure. Please see below to ensure you are directing your grievance to the appropriate point of contact.
Housing Program Grievances are related to a program participant's experience with a specfic homless housing program, its staff and/or eligibility decision. If you disagree with an activity or staff member at a shelter where you’re staying, you should submit an agency grievance and follow the agency’s grievance procedure. If an agency says you're not eligible for a program, use the agency's grievance policy to address the issue. All grievances that cannot be resolved to the satisfaction of the participant through the agency’s grievance process may be submitted to The Planning Council in writing. The Executive Committee of the SVHC will review your grievance and respond in writing within 30 days.

Coordinated Entry Policy and Procedure Grievances are connected to a participant’s experience with the SVHC Coordinated Entry System (CES) and how CES policies and procedures have affected their household's ability to navigate through the system. Common examples may include an Outreach worker or Coordinated Entry Access point refusing to input data into the CES project despite confirmed eligibility and consent or failure of a CES system point to screen you for appropriate resources. All CES grievances may be submitted to The Planning Council in writing. The Executive Committee of the SVHC will review your grievance and respond in writing within 30 days.
To ensure a prompt response to your SVHC Participant Grievance Form, please share the best contact method for us to reach you regarding this grievance.
Name

First NameLast Name
Mailing Address (if any)

Street Address

CityState / Province

Postal / Zip Code
Phone Number (if any)
Please enter a valid phone number.Format: (000) 000-0000.
Email (if any)
example@example.com
Event Leading to Your Grievance Submission

Briefly describe the incident that prompted your grievance, including dates, locations, and key individuals involved. We ask for these details to better understand your situation and address your concerns effectively.
In accordance with the SVHC Participant Grievance Policy, I am formally submitting a grievance for the following:
Please explain in detail the approximate date of the event, names of organization(s)/person(s) involved, and the purpose behind this grievance:
Please explain your suggestion and what action(s)you would like to see to resolve the grievance:
If you are a person with disabilities in need of reasonable accommodation(s) please list the specific type of assistance you are requesting:
If you have limited English proficiency and are in need of an interpreter, please list the language for which you will need interpreting services available:
By signing below, I verify all information included in is true and accurate

Participant's Signature:
Date* This is a fill in the field. Please add appropriate fields and text.
Should be Empty:

Southeastern Virginia Homeless Coalition Participant Grievance Form

Event Leading to Your Grievance Submission