OSC FORMAL COMPLAINT FORM
DISCIPLINE & APPEAL PROCESS
1. Date Submitted: ________________________
2. Complaint by: __________________________
3. Status/Official Position (President, Coach, Parent, etc.): _______________________
4. Phone Numbers: w)_____________________(h)_____________________________
5. E-mail Address: _______________________________
6. Mailing Address (must be a residence or business street address, not a PO Box)
7. Please summarize the complaint/violation and the relevant OSC governing Policies
and Procedures alleged to have been violated. If additional space is needed, you may
attach additional pages.
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8. State Name of alleged violator: ________________________
9. Alleged violator’s Phone number (if available): ________________________
10. E-mail Address (if available): _____________________________
11. In order to state a valid complaint, you must specify in reasonable detail all relevant
factual allegations (e.g. persons involved, locations of events, chronology of events,
etc.) of which you have personal knowledge. You may attach additional pages.
Unspecified allegations based on hearsay generally will not be sufficient.
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OSC FORMAL COMPLAINT FORM – DISCIPLINE & APPEALS
12. Name of Witness(es) Status/Title (Referee, administrator, coach, parent) Phone
Number
1.______________________________________________________________
2.______________________________________________________________
3. ______________________________________________________________
4. ______________________________________________________________
Additional Comments:
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Name of Association Discipline and Appeals (D & A) Representative:
I verify my knowledge of this complaint being filed Oxford Youth Soccer Association’s
Discipline and Appeals Committee.
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Signature of Association D&A Representative Date
PLEASE ATTACH SUPPORTING DOCUMENTS (Examples: letters, match report, email, Referee report, etc.)
Mail to: OSC – Attn: Discipline & Appeals – 104 Belle Street, Suite #1- Oxford, NC
27565