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Attachment B GRIEVANCE AND APPEAL FORM If you need assistance completing this form, you may contact your Community Mental Health Provider (CHMP) and request help from a staff member other than the

How to fill out grievance and appeal form

How to fill out a grievance and appeal form:

1. Begin by carefully reading the instructions provided on the form. Familiarize yourself with the purpose of the form and the process involved in filing a grievance or appeal.
2. Provide your personal information accurately. Fill in your name, contact details, and any other required identification information.
3. Clearly state the reason for your grievance or appeal. Use concise and specific language to describe the issue or decision that you are disputing. Include relevant dates, names, and any supporting documentation if necessary.
4. If there are multiple sections or questions on the form, complete each section fully and accurately. Take your time to provide all the required information, ensuring that you don't leave any fields unanswered.
5. Use a polite and professional tone throughout the form. Avoid using offensive or inflammatory language, as it may undermine the seriousness of your grievance or appeal.
6. Double-check your form for any errors or omissions before submitting it. Ensure that all the information provided is accurate and complete. If possible, have someone else review the form to catch any mistakes that you might have missed.
7. Keep a copy of the filled-out form for your records. This can serve as a reference in case there are any discrepancies or issues with your grievance or appeal.
8. Submit the form as per the instructions provided. Be mindful of any deadlines mentioned and make sure to follow the specified submission process. This may involve sending the form via mail, email, or delivering it in person to the relevant department or organization.

Who needs a grievance and appeal form:

1. Employees who feel that they have been treated unfairly at their workplace, such as being subjected to discrimination, harassment, or wrongful termination, may need to fill out a grievance and appeal form to address their concerns.
2. Students who want to contest academic decisions, such as grades, disciplinary actions, or admissions decisions, may be required to complete a grievance and appeal form.
3. Individuals receiving benefits or services from government agencies or organizations may need to use a grievance and appeal form to challenge decisions related to their benefits, such as denial or reduction in benefits.

Note: The specific requirements and processes may vary depending on the organization or institution administering the grievance and appeal form. It is important to follow their guidelines and seek any additional information or support if necessary.

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