SCOA Complaint Form - Disposition

SCOA COMPLAINT FORM

Subject:

File Number:

(to be filled in by office) (to be filled in by office)

Disposition of Complaint: Case Closed ( ) Case Open ( ) The following action is being taken:

Name:

Signature:

Date:

Name:

Signature:

Date:

Name:

Signature:

Date:

ADDENDUM

SCOA BOARD OF DIRECTORS ACTION TAKEN

Please completely describe all official actions of the Board of Directors, including all official motions in their entirety which were made and passed by the Board.

Board of Directors Signatures

Block 1

Block 2

Block 3

Block 4

Block 5

Block 6

Block 7

Block 8

Block 9

Agree Disagree (strike/check one) with the SCOA Board of Directors actions on this matter. If you disagree, enter your remarks here:

Complainant's Signature:

Date: