Ethics Complaint Form

This form is used to file a formal ethics complaint against a Michigan Certification Board for Addiction Professionals (MCBAP) professional and those in a development plan.

Prior to completing the ethics complaint, please:

  1. Confirm that the individual has a MCBAP credential:
  2. Review the applicable Code of Ethics:
  3. Review the Guide for Ethical Standards Violation Complaints.

Your information (complainant)

Complainant Name(Required)
Complainant Address(Required)

Complaint filed against (respondent)

Respondent Name(Required)
MCBAP credential(s) held(Required)
Respondent Address

Other Persons

List other persons who might have information pertinent to your complaint.

Person 1

Person 1 Name
Person 1 Address

Person 2

Person 2 Name
Person 2 Address


Describe the conduct that is the basis of your complaint. Please include the dates the conduct occurred and any other facts pertinent to the investigation of your complaint. Please provide as much concise detail as possible. Include applicable attachments.

Drop files here or
Max. file size: 256 MB, Max. files: 10.
    Attach any files (e.g. photos, documents) that support your complaint.
    This field is for validation purposes and should be left unchanged.