Complaints
Complaints
- Online Consumer Complaint
- Online Employer Complaint
- Online Program Complaint
- VDAP Application/Self-Report

Program Complaint Form

Please mail any supporting documentation to: Alabama Board of Nursing; Nursing Program Complaint; P. O. Box 303900 Montgomery, Alabama 36130

Program Details

College/University or Entity Name:*

Is this college within the Alabama Community College System?:*

Yes

Are you a student?:*

Yes

Your Details

Your Name:*

Address:*

City:*

State:*

Zip:*

Phone:*

Email:*

Institution's Details

Full Name of the Nursing Program:*

Name of Nursing Program Director:*

Nursing Program Address:*

Nursing Program City:*

Nursing Program State:*

Nursing Program Zip:*

Complaint Details

Date of the complaint occurrence.:*

Ex: MM/DD/YYYY

Details of the complaint:*

(Give specifics including what happened, the Date, Place and Time of Occurrence)

Other people/witnesses who know of this possible violation:

List name, addresses and telephone numbers

Details of school grievance policy/procedure:*

Send copies of your filings and a copy of the final order

I CERTIFY THAT ALL INFORMATION THAT I HAVE PROVIDED HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I FURTHER CERTIFY THAT I HAVE READ THE ALABAMA BOARD OF NURSING LEGAL AUTHORITY AND FEEL THAT MY CLAIM HAS MERIT.

I AUTHORIZE THE ALABAMA BOARD OF NURSING TO SUBMIT MY COMPLAINT AND/OR ANY DOCUMENTS CONCERNING THE COMPLAINT TO THE OTHER APPROPRIATE ENTITIES, INCLUDING MY NURSING PROGRAM, THE ALABAMA COMMUNITY COLLEGE SYSTEM AND OTHERS AS ARE NECESSARY. I FURTHER HEREBY ACKNOWLEDGE THAT I HAVE SUBMITTED THE INFORMATION ABOVE BASED ON CREDIBLE AND VERIFIABLE INFORMATION SUPPORTING THE ALLEGATIONS CONTAINED IN THE COMPLAINT.

Submit Complaint