If no, please contact the worker's supervisor, program manager, or county
director. During our follow-up you will be asked if you attempted to resolve your concerns and the
name(s) of the persons you contacted.
If you wish to PRINT this form after entering your
information, please do so BEFORE you click the SUBMIT button. Use your
browser's print function in the File menu, NOT the Printer Friendly option near the top
of this page. Thank you. NOTE: Only the text you can see without scrolling will be
printed. If you have more text in the "Your Concern" field, you may wish to copy and paste it into a
word processing program such as Microsoft Word or Notepad, among others.