This is a sample letter to acknowledge receiving of
grievance from participant of representative of exchange program
EXCHANGE Program Address
City, State, Zip Code
Telephone Number
(TTY) / Hearing Impaired
Acknowledgement Letter For Receipt Of Grievance
[Date]
[Participant Name or Name of Representative]
[c/o Participant Name]
[Address]
Re: Acknowledgement of Receipt of Grievance
Dear Mr/s. [Name]:
This letter is to inform you that [Exchange Program]
received your grievance on [Date] regarding [insert brief statement of
Participant’s grievance]. Please find enclosed a description of the
[Exchange program] Grievance Process, including notification of your right to
request a State hearing at any time during the grievance process.
We take your grievance very seriously and are
continuing to work toward resolving the issue to your satisfaction.
Within thirty (30) calendar days of receiving your
grievance, [Exchange Program Staff] will provide you with a written response
about the findings of the investigation and the action taken to resolve the
grievance. If you feel that waiting thirty (30) calendar days represents
a serious health threat, we will expedite the review process to a decision
within 72 hours of receiving your grievance. You may contact [Designated
Individual] at [insert regular and toll-free (as applicable) telephone
number(s)] at any time for information about your grievance. For the
hearing impaired (TTY), please call [number].
Thank you for working with us to resolve this matter.
Sincerely,
[Designated Individual]
/Enclosures
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