Client Grievance /
Formal Complaint Form

Clients may use this form to submit a formal grievance or complaint in response to the services they received from Bethany. Clients are encouraged to speak with a supervisor if they have concerns and would like them addressed before submitting a formal grievance.

Grievance Form Policy - English Grievance Form Policy - Haitian Creole Grievance Form Policy - Haitian French Grievance Form Policy - Mam Grievance Form Policy - Pashto Grievance Form Policy - Kekchi (Q'eqchi) Grievance Form Policy - Dari Grievance Form Policy - Spanish

First Name

Last Name

Street Address

Street Address Line 2

City

State

Postal Code

Phone

Location of Bethany Office

Program

Please provide a brief summary of your grievance/complaint

Describe how you would like for your grievance/complaint to be addressed

Client Grievance /Formal Complaint Form

Headquarters

Client Grievance /
Formal Complaint Form