Applicant or Client Appeal Form

If you were satisfied with our services, we appreciate knowing about it!

Individuals have a right to express dissatisfaction with the Center or its services in the following circumstances:

  • Applicants are not satisfied with the Center’s intake or information and referral services;
  • Clients are not satisfied with the Center’s advocacy services; and
  • Applicants and clients, their family members or representatives are not satisfied with the Center’s operation of its program(s).

Individuals using this process are called Appellants and shall be treated respectfully by Center representatives and will be guaranteed that there will be no retaliation for invoking this process.  The Center will provide assistance with reasonable accommodations or reasonably necessary auxiliary aids and services necessary for processing the complaint.

Step 1:  A written or oral appeal should be made to the Center within 30 days of the decision or action that prompted the complaint.  The appeal shall include the name, address, and telephone number of the Appellant; the action that is being appealed, and a description of the reasons why the Appellant believes the action should be changed.

An Appellant may appeal orally.  However the Center shall record any oral complaint on a standard recording device.

An appeal must be in writing if filed by an Appellant’s representative.  If the Appellant is represented by another person (not an attorney, or parent where the Appellant is a minor) the complaint shall include either: (1) a copy of a court order designating the representative as a guardian or conservator; or (2) a designation of representative, on the form which shall be provided by the Center and signed by the Appellant.

The Center shall appoint the Executive Director to respond to the Appellant in person, by telephone, by letter, or by tape and attempt to resolve the dispute.  The assigned staff shall provide a final written decision within 30 days of the date the complaint was received by the Center.

Step 2:  If the Appellant is not satisfied with the decision of the Executive Director in step 1 above, the Appellant may request a review of the decision on appeal by the Board of Directors of the Center.  Such request for review shall be made within 30 days of the date of the final written decision of the assigned staff on the Appeal.

A Request for Review shall be addressed directly to the Executive Director of the Center, and shall be submitted either in writing, or in the form of the original appeal.  Within 10 days following receipt of the Request for Review, the Executive Director shall schedule the hearing for not less than 10, nor more than 45 days following the receipt of the Request for Review.  The Appellant and/or Appellant’s Representative (if any) shall be permitted to attend this hearing.  The decision of the Board will be sent in writing or by oral recording within five working days following the meeting.  The decision of the Board is final.

Send all Complaints and Correspondence to:
EXECUTIVE DIRECTOR
Hawaii Disability Rights Center
1132 Bishop Street, Suite 2102, Honolulu, HI 96813