Formal Complaint
The LBGT PA Caucus Mentor Program does not tolerate any form of bullying, hateful or insensitive speech or any actions with the intent to cause harm from any member of the Mentor Program. We are sorry that you have experienced any grievance within the program. We will take the necessary action to resolve the issue(s) as soon as possible.
Please fill out the formal complaint form below to report an incident within the Mentor Program. If needed, you may fill out the form anonymously. Your formal complaint will NOT be shared with the offending party or parties. Each answer will be reviewed by the Incident Management Team, which is comprised of 3 individuals that hold leadership roles within the caucus. You will be notified with the results via email. If do not wish to be contacted regarding the incident, please specify below. The appropriate next steps will be determined after careful review of your formal complaint.
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Name (If you prefer to remain anonymous please write "Anonymous") *
Email (if you prefer not to be contacted regarding the incident please write "N/A") *
What is your role in your mentor group? *
Please describe the incident with as much detail as possible including the approximate date of the incident and whether or not this is the first occurrence. *
Do you wish to take formal action regarding the incident? *
Would you like to be reassigned to a new mentor group? *
Would you like to be removed from the LBGT PA Caucus Mentor Program? *
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