TNNAC Complaint Form
Use this form if you have any concerns or complaints
about TNNAC's caucuses or convention.

If you would like us to respond to you, we will need your name and an address, either USPS mail or email.
If no address is given, your concern/complaint will not be brought up at the next TNNAC board meeting.

TNNAC will respond to every written complaint in writing. 
Complaints must be received by TNNAC within fourteen (14) days of the action, 
and contain specific information about the date, time, location, event, 
and full names of persons involved, including your location at the time, 
and how you were/are directly affected by this alleged activity.  Also 
describe the rule or principle alleged to have been violated, and please provide 
the full name, address and phone number of any witnesses to the alleged incident. 
Anonymous submissions will not be investigated.


Please print and fill out as much of the following form as possible so that 
we can better understand your concern/complaint and address it quickly.


            Your Full Name: ____________________________________________________
            
      Your Mailing Address: ____________________________________________________	
      
        Your Email Address: ____________________________________________________
        
         Your Phone Number: ____________________________________________________
         

       Name/Title of Event: ____________________________________________________
       
             Date of Event: ____________________________________________________
             
         Location of Event: ____________________________________________________
         
             Time of Event: ____________________________________________________
             
Your Purpose/Role at Event: ____________________________________________________


      Location of Incident: ____________________________________________________
      
          Time of Incident: ____________________________________________________
          
    Your Concern/Complaint: ____________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(Please be as brief as possible, but feel free to use more space as needed.)



Rule or Principle You Believe Was Violated: ____________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________


           Other Person's Name:	________________________________________________
            
      Address/Phone (if known): ________________________________________________	
         
Other Person's Role/Title in Event: ____________________________________________


                 Witness 1: ____________________________________________________

                            ____________________________________________________

                 Witness 2: ____________________________________________________

                            ____________________________________________________

                 Witness 3: ____________________________________________________

                            ____________________________________________________


Please sign, date, and send your concern or complaint to:
TNNAC Vice ChaIr Vicky Garland, 55 CC Road, Lawrenceburg TN 38464
or by email: TNNAC Vice ChaIr Vicky Garland {vlg42(at)hotmail.com}.
And please be sure to keep a copy of the complaint for yourself.

Thanks.

last updated: . 28mar07