CLIENT GRIEVANCE - LEVEL 2 **THIS FORM MAY BE FAXED TO (816) 257-9350; EMAILED TO tfrancis@hopehouse.net; OR MAILED TO PO BOX 577, LEE’S SUMMIT MO 64063 Today’s Date: _________________ Name:
________
Safe way to be contacted:
State problem or concern including the date of the event or timeline of events that led to this grievance:
Desired Outcome:
Signature of Individual Submitting Grievance
Date
Response/Resolutions from Hope House Personnel
Signature of Hope House Personnel
Date