Please complete this grievance form if you wish to submit a complaint about a decision made by the Peer and Family Support Certification Committee regarding your certification. You may use this form if your certification has been denied, suspended, or revoked; if you question the results of the application review process; or if you are subject to an action you feel is unjustified.
You must submit your grievance in writing within 30 calendar days of notification from the Peer and Family Support Certification Committee regarding the certification decision. Your grievance must include all information requested on the following form.
Please upload any documentation you wish to submit in support of your grievance.
My signature below affirms that all of the information contained in and attached to this grievance is true and correct. I understand that knowingly providing false information shall be grounds to deny, revoke or suspend my certification.