Online Grievance Form
Complete information below to request your grievance.
Requested Date:
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Day
Year
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Submitted By:
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Please Select
Resident
HACF Staff
Power-of-Attorney
If HACF Staff, enter ID to continue:
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Full Name:
*
First Name
Last Name
Phone Number
*
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Area Code
Phone Number
I currently live at:
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Please Select
Westview
Willow
Douglas Village
Gilmore
Parkside
Lincoln Village
Hosmer
Brewster
Street Address:
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Street Address
City
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What's the best time to call you?
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Please Select
8:00am - 10:30am
10:30am - 12:00pm
12:00pm - 2:30pm
2:30pm - 4:30pm
After 4:30pm
ANYTIME
Type of Grievance:
*
Please Select
Informal - 1st
Formal - 2nd
Action or Relief Sought:
*
Please Select
Cancel 30-Day Termination of Lease
Cancel 14-Day Termination of Lease
Cancel Lease Violation
Dispute Outstanding Balance Owed
Dispute Rent Amount
Other - Explain in next Box
Other (Explain Below):
Reason you are requesting grievance:
*
Upload supporting documentation:
Preferred Date/Time you would like to meet:
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Month
/
Day
Year
Date
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Hour
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30
45
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AM
PM
AM/PM Option
Would you like a response by email?
*
Yes
No
E-mail:
*
Status:
Please Select
SCHEDULE INFORMAL
SCHEDULE FORMAL
To Meet with:
Please Select
Felice Woitynek, PHM
Vikki Brinker, PHM
Andra Taylor, PHM
Larry Williams, CEO
Email:
Please Select
fwoitynek@hacf.us
vbrinker@hacf.us
ataylor@hacf.us
lwilliams@hacf.us
Extension(s):
Please Select
1060, 1070 or 1080
1040 or 1050
1030
1015
Meeting Location:
Please Select
Main Office, 1052 W. Galena Avenue, Freeport, IL 61032
Westview Office, 1425 Westview Road, Freeport, IL 61032
Parkside Office, 701 E Orin Street, Freeport, IL 61032
Hosmer Office, 601 N Walnut Avenue, Freeport, IL 61032
Brewster Office, 1050 W. Galena Avenue, Freeport, IL 61032
Willow Office, 526 N Willow Avenue, Freeport, IL 61032
Date & Time:
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Month
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Day
Year
Date
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5
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8
9
10
11
12
:
Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
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