Suggestion and Concerns Form – Atikameksheng Anishnawbek

Atikameksheng Anishnawbek Suggestions and Concerns Form

Atikameksheng Anishnawbek (AA) seeks feedback from members that receive services from our programs, and clients as an opportunity to improve the quality of services being delivered. Providing a safe and efficient process for giving and receiving feedback will help Atikameksheng Anishnawbek respond to the needs of its members. Atikameksheng Anishnawbek is committed to addressing suggestions and concerns regarding our programs and services by: • Informing the administration of concerns regarding the organization, programs, policies and/or personnel. • Acknowledging receipt of the suggestions and concerns. • Treating all information with a high level of sensitivity. • Ensuring follow up in a timely fashion.

Name:(Required)

Address:(Required)

Phone #(Required)

Email:(Required)

Date Filed:(Required)

How Would You Like Us To Contact You?

What is your Suggestions and Concerns About?

Please provide as much information as possible regarding your suggestion or concern.

(If this is about an event/incident please provide details such as where the event happened, the date of the occurrence, any witnesses, etc. Please describe how this event/incident affected you.)

What is your recommendation?

Consent

I certify that the information provided is true, correct, and complete to the best of my knowledge and belief. I understand that Atikameksheng Anishnawbek will do their best to protect my privacy but may have to disclose some information to the person(s) involved to resolve this matter. Information provided is subject to the Freedom of Information and Protection of Personal Privacy Act.

Atikameksheng Anishnawbek Suggestions and Concerns Form

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