OTAC Member Grievance/Complaint Form
Your Name:
*
First Name
Last Name
Your Email:
*
example@example.com
Phone Number:
*
-
Area Code
Phone Number
Name of Person that Complaint is Filed Against:
*
Event in Which Incident Occurred:
*
Date of Incident:
*
-
Day
-
Month
Year
Date
Detailed Description of Incident:
*
Name(s) of Possible Witnesses:
Signature:
*
Date:
*
-
Month
-
Day
Year
Date
Member #:
*
Submit
Should be Empty: