Form — Grievance Request Form - Salish and Kootenai Housing Authority

IN CASE OF MAINTENANCE EMERGENCY

Contact Tribal Law & Order at 406.675.4700 and ask for the on-call maintenance worker.

GENERAL INQUIRIES & INFORMATION

Phone 406.675.4491

Fax 406.675.4495

Email rquequesah@skha.org

Physical Mail P.O. Box 38, Pablo, MT 59855

Office 56243 US Hwy 93, Pablo, MT 59855

Hours 7a.m.–5:30 p.m., Mon–Thurs

(Except, Tribal Holidays or Tribal designated days.)

Grievance Request

"*" indicates required fields

This form is to be used to initiate a response from the Housing Authority regarding any action taken against an individual or failure by Housing Authority to take action regarding a request or complaint by an individual. A letter requesting action and signed by the individual may substitute for a Grievant Request Form.

Please fill this form out completely and return it to the Housing Authority office. A response will be received within ten working days from the date the Request is received.

Name*

First Last

Date*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Unit #*

Phone*

Brief Description of Complaint*

Action Requested by Grievant*

Signature*

Date*

Grievance Request Form

Grievance Request

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