Rainbow Community Center Grievance Form Question Title * 1. Type of complaint: Cleanliness/issue with the physical space Discrimination Lack of responsiveness/unsatisfactory response time Program failed to meet expectations Other (please specify) Question Title * 2. In which program did the issue take place? Question Title * 3. Date/time of occurrence Date / Time Date Time AM/PM - AM PM Question Title * 4. Please provide a brief description of the incident. Question Title * 5. Have you attempted to address the issue with program staff? Yes No Next