MRCCB Ethics Complaint Form

This form is to be filled out by any person registering a complaint with the Maine Recovery Coach Certification Board (MRCCB) concerning a Registered/Certified Peer Recovery Coach or a person applying for registration/certification.

If you prefer to print and mail this form, download this pdf version.

Ethics Complaint

Part I
Part II
Part III
Part IV
Part V
Part VI

Person registering complaint:

Name *

First

Last *

Last

Address *

Address

City

State/Province

Zip/Postal

Phone *

Mobile/Preferred

Home Phone

Home

Business Phone

Business

The Registered/Certified Peer Recovery Coach or applicant against whom the complaint is being registered:

Name *

First

Last *

Last

Business Address *

Business Address

City

State/Province

Zip/Postal

Phone *

Mobile/Preferred

Nature of Complaint

Check each complaint that is appropriate.

Violation of the Maine Peer Recovery Coach Code of Ethics

Violation of applicable Federal or State Law

If you are human, leave this field blank.

Person registering complaint:

The Registered/Certified Peer Recovery Coach or applicant against whom the complaint is being registered:

Nature of Complaint

This project has been made possible with funding provided by:

Connect With Us