Coru Community Grievance Form

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The information you provide below will help us resolve the conflict. Your response is fully voluntary, but please bear in mind that incomplete information may make it difficult or impossible to properly resolve the matter. You may choose to end your participation in this process at any time, regardless of how far along the process has progressed.

Email *

Preferred or Community Name

Legal Name (if different from above and not a deadname)

Name of person or persons involved

Phone number

Date of form submission

YYYY

Please indicate which of the following form(s) of harassment and/or discrimination occurred:

Age

Ancestry

Disability

Gender

Marital Status

Medical Condition

Political Affiliation

Pregnancy

Race and/or Ethnicity

Religion

Retaliation

Sexual Harassment

Sexual Orientation

National Origin

Other:

Clear selection

Please describe what happened. Concrete details about who was present, where and when it occurred, what was said (as best as you can remember), what other actions were committed, and how it impacted you is helpful. You may use as many or as few pages as necessary.

Approximate date that misconduct occurred:

YYYY

Location:

What might a resolution for this incident look like for you? This gives the Coru officers insight into what kinds of approaches the Coru could use to most effectively address the misconduct.

Consent for Investigation & Service

By signing below, I understand that I’m filing a formal grievance with the Coru Cathubodua Priesthood. I authorize reasonable investigation of my grievance and the revealing of my identity ONLY as absolutely necessary for Coru officers to fulfill their responsibility in the process described above. I understand that members of the Coru priesthood, which includes Coru officers, are mandated reporters and that I have the right to ask for clarification where mandated reporting laws become relevant before I disclose any personal information. I understand that I am allowed to end my participation in this process at any time without repercussion or retaliation for doing so.

Name:

Date:

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