HOUSING FIRST SOLANO

Full name of complainant *

Date, time and place of incident *

Details of incident *

If voluntarily provided, list any third-party documentation you are providing along with this notice

Participant Grievance Submission

Your name (if different from complainant)

Are you currently receiving homeless services in Solano County?
Have you been discharged from a program or denied housing or services?
Do you have a complaint about those services you would like to submit?

If so, please fill out the form below.

The Housing First Solano Continuum of Care (CoC)/CAP Solano JPA Participant Grievance Policy applies to all participants in housing and homeless service programs funded by the CAP Solano JPA and/or the Housing First Solano Continuum of Care (HFS CoC). This policy provides participants with the right to grieve any situation where they are denied housing or services by a program. This covers denials of housing or services because of rule violations, non-compliance with program requirements, or not meeting program eligibility.

The goal of this policy is to provide program participants and service providers with a fair and equitable process. If you are a participant in a JPA/CoC-funded housing or homelessness program in Solano County and have been issued a denial of housing/services from a JPA/CoC-funded agency, you may submit an Appeal Request Form or complete the form below. You may also complete the following form to request an investigation if you have a complaint that is not being or has not been addressed through the Participant Grievance Policy.

This form should be completed by the participant but may be written by someone on the participant's behalf. The form and personal information will be kept confidential. A confirmation of receipt and a date for review of the complaint should be received within 5 business days, not including Saturdays, Sundays, and holidays.

Complainant (or representative) signature *

Relationship to complainant (if representative)

Description of perceived inappropriate use or disclosure suffered *

Full name of complainant *

Proposed resolution *

Address or phone number for contacting the complainant

Phone

Your name (if different from complainant)

Full name *

What action or communication have you already taken to resolve your complaint? *

Signature *

The Housing First Solano Continuum of Care (C0C) does not tolerate discrimination based on actual or perceived membership in any protected class. The entirety of Housing First Solano’s Coordinated Entry process shall be conducted in compliance with the nondiscrimination provisions of federal civil rights laws, including the Fair Housing Act, Section 504 of the Rehabilitation Act, Title VI of the Civil Rights Act, and Titles II and III of the Americans with Disabilities Act, as well as HUD’s Equal Access and Gender Identity Rules. Under these laws and rules, the following classes are protected from discrimination: race, color, religion, national origin, sex, actual or perceived sexual orientation or gender identity, disability, familial status, or marital status.

All information provided to the CoC concerning incident(s) of discrimination shall be kept confidential. Such details shall not be entered into any shared database. Please see the Right to File Discrimination Complaints Notice and Form for more information.

Address or location *

Discrimination Complaint

Date(s), time(s) and location(s) of incident(s) *

Address or phone number for contacting the complainant

What was the result of the action or communication you took with that particular agency? *

Personally Identifiable Information Use or Disclosure Complaint

Name of the person or entity against whom this complaint is being filed (if known and can be safely disclosed) *

Date(s), time(s) and location(s) of incident(s) *

Description of perceived discrimination suffered *

All information provided to the Housing First Solano Continuum of Care (CoC) concerning incident(s) of improper use and/or disclosure of Personally Identifiable Information shall be kept confidential. Such details shall be stricken from any shared database until a pending complaint of improper use or disclosure is resolved. Housing provider employees are not to have access to these details unless to grant or deny relief as provided by federal or state law. Such employees may not disclose this information to any other entity or individual, except to the extent that disclosure is: (i) consented to by you in writing in a time-limited release; (ii) required for use in an eviction proceeding or hearing regarding termination of assistance; or (iii) otherwise required by applicable law. Please see Coordinated Entry Policies and Procedures, Attachment VI: Universal Privacy Notice for more information.

If voluntarily provided, list any third-party documentation you are providing along with this notice

Signature *

​Participant Grievance Submission

Discrimination Complaint

Personally Identifiable Information Use or Disclosure Complaint

Participant Grievance Submission