Code of Ethics - Member Complaint Form

Member Complaint Form
Note: All fields are required unless stated otherwise. Incomplete forms may delay the investigation process.
1. Complainant Details
Full Name

First NameLast Name
Organisation (if applicable)
eg ACME Inc.
Role/Position (if applicable)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
Are you submitting this complaint on behalf of a public agency, organisation or community group?
If yes, please provide the following details:
Name of Organisation
Key Contact

First NameLast Name
Email
example@example.com
Mobile
Please enter a valid phone number.Format: (000) 000-0000.
2. Respondent Details
Name of the Engagement Institute Member
Organisation/Employer (if known)
3. Complaint Information
Describe the conduct at issue:(Include dates, context, and who was involved. Be specific.)
Which provision(s) of the Code of Ethics do you believe were breached?
(Refer to: https://cdn.ymaws.com/www.iap2.org/resource/resmgr/pillars/22x34_iap2_code_of_ethics_v1.pdf)
Explain why you believe the conduct breaches the Code:
4. Supporting Documentation
Please attach all relevant supporting documentation (emails, correspondence, reports,etc.).

Cancelof
List attached documents:
5. Your Interest in the Matter
Please describe your involvement or interest in the matter (e.g. client, affectedstakeholder, member of the public):
Do you have any existing relationship with the respondent or the Engagement Institute?
If yes, please describe:
6. Declaration
I declare that the information provided is true and accurate to the best of my knowledge. I understand that my complaint may be disclosed to the respondent as part of the complaints process.
Signature
Date

MonthDayYear
Date
Privacy

The Engagement Institute respects your privacy and the confidentiality and security of personal information provided by you to us. The information provided by you to the Engagement Institute on this form will be used by the Engagement Institute for the purposes of communicating with you in relation to this Complaint in accordance with our Privacy Collection Statement. Our Privacy Policy contains information about how you may access your personal information and seek correction of such information.
Should be Empty:

Member Complaint Form

1. Complainant Details

2. Respondent Details

3. Complaint Information

4. Supporting Documentation

5. Your Interest in the Matter

6. Declaration

Privacy