Beacons Complaint Form
A Beacons trainee, consumer or participant, or any representative acting on behalf of any trainee, consumer or participant, may file a grievance or share a complaint with Beacons, Inc. regarding Beacons and/or its activities and/or practices, a staff member or volunteer, or other item by completing this online Beacons Complaint Form.

This form will be submitted to Beacons, Inc. by clicking on the "submit" button at the end after all the "required" fields are completed. In the event you do not want to share your complaint or concern through this form, you may submit your concerns or complaints to the President of Beacons or the Executive Director, in person or via email to: BeaconsNorthCounty@gmail.com.

Please be as detailed as possible about your concerns or complaint so that we may work to resolve or address the concern or complaint as quickly as possible.

Thank you,
The Beacons Team
760-448-6230
BeaconsNorthCounty@Gmail.com
www.BeaconsNorthCounty.com
6150 Yarrow Drive, Suite E
Carlsbad, CA 92011


Email address *
Participant's Name *
Your answer
Is the Participant a SDRC Consumer? *
Participant's Birthdate (needed if a SDRC Consumer)
MM
/
DD
/
YYYY
Name of person filling out this form: *
Your answer
Relationship of person completing this form to Consumer (self, parent, sibling, SDRC service coordinator, etc.) *
Your answer
Telephone Number: *
Your answer
Mailing Address:
Your answer
SDRC Service Coordinator's Name: *
Your answer
SDRC's Service Coordinator's Email address: *
Your answer
WHAT HAPPENED? Please describe what happened so that we can understand your complaint: *
Your answer
What Beacons activity were you participating in at the time the problem happened? *
Required
If there is a person or people you are complaining about, please state their name and what they did:
Your answer
WITNESS(ES): Did anyone witness what happened? If so, please list the individuals present and their names (if known).
Your answer
SOLUTION? What is your proposed solution, or how would you like Beacons, Inc. to handle this situation? *
Your answer
Submit
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