Grievance Submission
Id grief
Full name
Organization/Company (if applicable)
Telephone Number (include country code)
Email Address
Preferred Contact Method
-- Select --
Phone
Email
Other
Gender
-- Select --
Male
Female
Prefer not to say
Country
-- Country --
Benin
Burkina Faso
Cabo Verde
Cameroon
Central African Republic
Chad
Côte d'Ivoire
Gambia
Ghana
Guinea
Guinea-Bissau
Liberia
Mali
Mauritania
Niger
Nigeria
Senegal
Sierra Leone
Togo
City/Town/Village
Are you submitting this grievance on behalf of someone else?
-- Select --
Yes
No
Name of person represented
Relationship to you
Date of Incident/Issue
Project Component/Activity Involved (if known)
Please describe your grievance/concern in detail
Category of Grievance (select all that apply)
Capacity building/training
Child protection concern
Discrimination or inequitable treatment
Environmental concern
Fraud, corruption, or bribery
Grant application or feedback
Occupational health & safety
Other (please specify)
Privacy/data protection
Request for updates or information
Sexual exploitation, abuse, or harassment
Please specify other category
Have you previously reported this issue to ROGEAP or another organization?
-- Select --
Yes
No
If yes, please specify when and to whom
Supporting Documents (Files)
Desired Outcome/Resolution Sought / Please describe what action or resolution you seek
Anonymity and Confidentiality / Would you like your identity to remain confidential?
-- Select --
Yes, keep my identity confidential
No, I allow my identity to be shared with those handling the grievance
Anonymity and Confidentiality / Do you fear retaliation for making this complaint?
-- Select --
Yes
No
Anonymity please elaborate
I confirm that the information provided is accurate.
Submission Date
SUBMIT GRIEVANCE