(207) 389-5105 info@peerrecoverycoachme.org

Maine Peer Recovery Coach Certification Board

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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:

First
Last
Address *
Address
City
State/Province
Zip/Postal
Mobile/Preferred
Home
Business

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

First
Last
Business Address *
Business Address
City
State/Province
Zip/Postal
Mobile/Preferred

Nature of Complaint

Check each complaint that is appropriate. *

This project has been made possible with funding provided by:

MRCCB c/o PRCC
102 Bishop Street
Portland, Maine 04103

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Phone: (207) 389-5105
Email: info@peerrecoverycoachme.org

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