Complaint Form

The Washington State Office of the Family and Children’s Ombuds can only investigate complaints that involve agencies in the State of Washington.

* = required information

Please review messages shown below, correct and resubmit form

What is your relationship to the child or family?*

Ethnicity (Optional)

Primary Language (Optional)

 

Other:

Do you need interpretation or translation services?


Parent

Parent Information



Ethnicity (Optional)

Primary Language (Optional)

Other:

Is the parent currently represented by an attorney?*

Yes No I don't know

Child

Children Information




Gender * Female Male

Ethnicity (Optional)

Primary Language (Optional)

Other:

Is the child currently represented by a CASA or GAL?* Yes No I don't know
Is the child currently represented by an attorney?* Yes No I don't know

With whom does the child reside?*




DSHS Caseworker

Who is the family's current DSHS caseworker?


Subject of your complaint

If your complaint involves multiple subjects, you may address the additional subjects in conversations with your assigned Ombuds.

Please check this person's agency or profession

DSHS


What is your complaint?

Provide a BRIEF SUMMARY of the agency action or inaction that you are complaining about and the date or dates of the incident(s). You can provide more specific detail when an ombud contacts you.* Example: My nephew was placed in foster care and my nephew's caseworker is refusing to place him with me because my husband has a criminal record.


Please describe the reason you think the agency action or inaction was wrong or unreasonable.* Example: Be brief, but provide as many facts as you can.


What action are you seeking to resolve your complaint?* Be as specific as you can. Example: I want the caseworker to reconsider letting my nephew live with me..


How did you hear about the Family and Childrens' Ombuds?








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