Request edit access
All clients/students have the right to informally and formally document grievances. If the client/student is unable to fill out this form, due to disabilities such as unable to read or write, a staff member or advocate of their choice will give assistance to file a grievance.
Any questions regarding this form or grievances can be directed to Pastor Christina Hough, Director of Spiritual Care/Liaison at
or at ext 1150.
Name/Relationship/Contact Information of Person Initiating
Type of Request
Submitted to (Name/Title)
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This form was created inside of Glade Run Lutheran Services.