CoC Member Agency Grievance Form

Your Name

Mailing Address

Street Address Address Line 2 City State ZIP Code

Email Address

Phone Number

Response Preference

Mail

Email

Phone

Name of agency to which you are filing a grievance

Have you completed the agency's internal grievance procedure?

Summary of grievance

You may upload documentation related to the grievance here

Drop files here or

Max. file size: 64 MB.

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2001 Haskell Avenue
Lawrence, KS 66046