Provider Complaint Form

Provider
Complaint Form

The purpose of this form is to submit complaints regarding CTEC approved education providers. Please complete the appropriate information below related to your complaint and then click submit.

* required fields

Submitted By:

Name of Person Submitting Complaint *

Address *

City/State/Zip *

Phone *

Email *

Check One:

CRTP - Enter Number

CTEC Provider - Enter Provider Number

Other (Describe relationship with CTEC):

Provider Information:

Provider Name *

Provider Number

Course Name *

Course Number

Complaint Details: *

ProviderComplaint Form

Submitted By:

Check One:

Provider Information:

Subject of Complaint (check all that apply)

Provider
Complaint Form