Grievance Form

Maricopa Regional Continuum of Care Grievance Form

This form is to be used by those who have been served by homelessness services in the Maricopa Regional CoC. Clients who have complaints pertaining to services received from a CoC agency are encouraged to file a grievance with the specific agency. If this action has been completed and the issue remains unresolved, please use this form.

Contact Information
Accurate contact information is important to ensure CoC staff can contact you, however you have the right to remain anonymous.
Name
HMIS Number (if known)
Phone Number
Email Address
Please provide the best way to contact you if you would like follow-up on your submission
Phone
Email
Grievance Information
Program that served you
Program Location (if applicable)
Have you completed a grievance form with the agency that served you?
Yes
No
If no, please describe why
Issue Occurrence Date(s)
Issue Description

Grievance Form

Maricopa Regional Continuum of Care Grievance Form

Contact Information

Grievance Information