Morris County, NJ

webmaster@co.morris.nj.us

PO Box 900, Morristown, NJ, 07963-0900, US

Morris County Continuum of Care Grievance Form

Name of person filing complaint:

Email:

Phone:

Which best describes you?

Consumer

Funded Provider

Would you like to submit this grievance anonymously?

Yes

Who are you filing a grievance against?

CoC Executive Committee

CoC Executive Committee Member

CoC Lead Agency

Contracted Consultant

Funded Provider

Member's Name:

Funded Provider's Name:

Please provide a description of your grievance. Be as specific as possible. Include dates as needed.

You may upload supporting documentation:

Click Here to Upload

If you are a consumer, did you attempt to address this complaint with the agency?

Yes

Why not?

What date was the grievance first made?

Who did you file the grievance with?

Please describe the outcome of the grievance:

Consumer Advocate (if applicable)

A consumer advocate is someone who is assisting with completing this form or navigating through the grievance process such as a case manager, friend or family member.

Consumer Advocate's Name

Consumer Advocate's Phone

Consumer Advocate's Email

Consumer Advocate's Agency