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SCI Feedback, Concerns & Grievances Form

SCI values open communication and welcomes feedback from individuals receiving services, families, caregivers, employees, schools, community partners, and others connected to our organization. We encourage you to share positive experiences, suggestions for improvement, questions, concerns, complaints, or grievances. Your feedback helps us recognize what is working well, address concerns, and continually improve our services and practices.

You may use this form to provide feedback about any SCI service, program, employee, or location. Submissions may be made anonymously; however, we cannot provide a direct response or follow-up without contact information. SCI is committed to reviewing concerns respectfully and fairly, without retaliation against individuals who raise concerns in good faith.

If someone is in immediate danger or needs emergency assistance, please contact the appropriate emergency services rather than using this form.

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Who are you in relation to SCI?
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Would you like to identify yourself? Note: Anonymous submissions can be reviewed, but SCI will not be able to provide you with a direct response or follow-up.
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Your Name (If you answered "yes" to the previous question)
Preferred Contact Method
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Email Address
Phone Number
Which SCI service or program is this related to?
Who or what is your concern about? You may provide the name of a person, program, service, location, or other identifying information that will help SCI understand the concern.
When did the concern occur?
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If this concern occurred over a period of time, please describe.
What type of concern would you like to share?
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What type of feedback would you like to shar. Please provide as much information as you feel comfortable sharing. Include what happened and any information you believe would help SCI understand the feedback.
Have you already discussed this feedback with someone at SCI?
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If yes, who did you speak with and what happened?
If this was a concern, what would you like SCI to consider as a possible resolution? You do not have to propose a resolution. This question simply gives you an opportunity to tell us what outcome or support you are hoping for.
Is there anything else you would like us to know?
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