STANDARD - VSL - Transparent

Vanderburgh Sober Living
(844) 762-3747
www.vanderburghhouse.com

💜 Vanderburgh Sober Living^TM is a cooperative
network of independently operated recovery residences
organized by The Vanderburgh Foundation, Inc.,
a registered 501(c)3 Charitable Foundation.

📋 Grievance Submission Form

Please use this form to submit a grievance relating to a Vanderburgh Sober Living home.

This form is intended for use after a solution to the problem has been attempted or in the case that you do not think a solution can be attempted outside of an official process.

Grievance resolution process:
1. First, fill out the form. Add as much information and be as clear as you can.
2. Next, someone will be in contact with you if they need to clarify any of the details.
3. Finally, someone will work on a solution to the issue.

Important Disclaimer: VSL does not use any of the information given in a grievance to retaliate or discriminate against the aggrieved party(s) or those who file on their behalf. The information submitted in this form may only be used towards investigation and resolution of the grievance.

Grievance title*

Please input a short title for this grievance

What type of grievance is this?*

What type of grievance is this? For example, what category of individual or topic is the grievance about?

Date of Incident

Month/Day/Year

Time of Incident

Grievance description*

Please describe the nature of this grievance, including:

1. What happened?
2. Where did it happen?
3. Who was involved?
4. What, if anything, have you done to attempt to resolve this?
5. What is the requested resolution?

Who are you in relation to this grievance?*

The information requested below will only be used so that we can contact you to folllow up with any questions we might have about the situation or the resolution. You can submit this form anonymously if you want, but we will not be able to contact you without this information.

Your first name*

Your last name

Your phone number

Your email*

In submitting this grievance, I confirm that I have attempted to resolve this directly with the other party(s) mentioned on this form, and I confirm that this information is true and accurate to the best of my knowledge.