Grievance Form

Instructions to Individuals Completing This Complaint Form

PRSA has created a grievance process that may be utilized to review certain conduct of PRSA members and those affiliated with PRSA. Before filing a complaint, please visit the Member Resources Library in MyPRSA for a copy of the PRSA Grievance Policy and Procedures and additional information.

In order to submit your complaint, please complete the Complaint Form below. When considering whether to file a complaint, please keep in mind that:
- Filing a complaint is a serious matter. Prior to filing a complaint with PRSA, you should attempt to resolve the concern directly, using all available channels. If you are unable to resolve the concern, you may file a written complaint with PRSA by submitting this Complaint Form online.
- PRSA can only act upon complaints filed against PRSA members, members of the College of Fellows or persons holding a certification or Accreditation issued by PRSA.
- The person filing the complaint must be a PRSA member, member of the College of Fellows or hold a certification or Accreditation issued by PRSA.
- PRSA does not accept anonymous complaints or complaints filed against an organization or employer.
- Grievances must address conduct that has occurred in the past year, except as otherwise described in the Grievance Policy and Procedures.
- Grievances must be brought in good faith and based on the criteria for disciplinary action as defined in the PRSA Bylaws and Policies and Procedures.
- To investigate a complaint, and in the interest of fair process, PRSA will disclose your identity, a copy of this Complaint Form and all supporting documentation received from you and other persons to the Respondent, PRSA staff members and volunteers involved in administering the Grievance Process, and possibly others.
- The process for filing a complaint is considered confidential. Complainants must maintain the confidentiality of their efforts to file a complaint, or any of the subject matter therein. Violations of confidentiality obligations in the Grievance Process are considered a violation of the bylaws and could result in the dismissal of the complaint or sanctions.
- Special care will be applied to all complaints; however, Complainants must be aware that PRSA will not tolerate abuse or attempted abuse of the Grievance Process.
PRSA endeavors to review grievance matters promptly. From start to finish the review process may take several months, depending on the particular circumstances of the complaint. You will be notified of PRSA’s actions once your complaint is processed and contacted if questions arise or additional information is required.

If you have any questions, please contact PRSA at (212) 460-1403 or grievance@prsa.org.
Complainant Information
Date of occurrence: (MM/DD/YYYY)*
Grievances may not be submitted addressing incidents that occurred prior to when the bylaw amendment was passed (Oct. 6, 2018) and must address conduct that has occurred in the past year, except as otherwise described in the Grievance Policy and Procedures.
MM slash DD slash YYYY
Are you a member of PRSA, the PRSA College of Fellows or holder of a certification or Accreditation issued by PRSA?*
- Yes
- No
The person filing the complaint must be a PRSA member, member of the College of Fellows or hold a certificate or Accreditation issued by PRSA.
Is the Respondent a member of PRSA, the PRSA College of Fellows or holder of a certification or Accreditation issued by PRSA?*
- Yes
- No
- I don't know
PRSA can only act upon complaints filed against PRSA members, members of the College of Fellows or persons holding a certification or Accreditation issued by PRSA.
Your Name:*
Email Address:*

Complainant Information (continued)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number:*
PRSA Chapter(s):
PRSA Section(s):
PRSA District:

Information regarding the Respondent against whom the complaint is filed.
Please complete the below to the best of your ability.
Name:*
Address (Street, City, State, Zip):
Phone Number:
Email Address:
PRSA Chapter(s):
PRSA Section(s):
PRSA District:

Complaint Overview
Provide an overview of your concerns, a statement of what you consider to be the essential facts involved and a description or any impact on individuals and/or the PRSA community. Please note, you will be asked additional questions about this complaint and have the opportunity to upload files later in this form.
Overview:*
Please take your time, be specific and provide as much detail as possible — the who, what, where, when and why of the matter. This should be a summary of the most important facts and evidence you believe support the undertaking of a formal review by PRSA. Generally, the more public or known facts that are provided on this form the more likely it is that your complaint will proceed through the Grievance Process.

Other Related Complaints
To the best of your knowledge, are there any other regulatory complaints, court actions or ethics complaints that have been filed by you or anyone else that relate to the same or similar allegations contained in this Complaint Form? If so, identify such complaints or other actions below.
Please describe other related complaints:
Witnesses
List all witnesses and any other information that could be valuable in the evaluation and ultimate resolution of the matters described in this Complaint Form. Please provide each individual's full name, address, telephone number, email address, and other contact information to the extent known. Witnesses will not be contacted until/unless the complaint is moved forward to a grievance panel.
Please list all witnesses:
Supporting Documents
Do you have other documents that are relevant to or support your report?
- Yes
- No
Please give details and upload copies:
File Upload
Maximum allowed file size is 8 megabytes each.
Drop files here or

Max. file size: 8 MB.

Actions
What actions have you (or your Chapter/District/Section) taken to address the situation with the Respondent?
Please describe actions taken:
History
Is this the first time you have submitted a grievance to PRSA regarding the respondent?
- Yes
- No

Statement and Certification
By entering my name and date below and submitting this Complaint Form, I agree to cooperate fully with PRSA in disposing of this complaint in accordance with its policies and procedures, and affirm that the statements and information submitted in and with this Complaint Form are made in good faith and not for any improper purpose, and are true and correct to the best of my knowledge.
Confirm*
Yes
Please type your full name:*
Date*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

PRSA Grievance Complaint Form

Step 1 of 7

Instructions to Individuals Completing This Complaint Form

Complainant Information

Complainant Information (continued)

Information regarding the Respondent against whom the complaint is filed.

Complaint Overview

Other Related Complaints

Witnesses

Supporting Documents

Actions

History

Statement and Certification