DRAFT Informal Complaint Form
Child Development Department

Contact Information

Name:

Address:

City:

Zip Code:

Phone Number:

Complaint or Charge

Is the complaint or charge against a preschool site or employee?: - None -Preschool SiteEmployee

Preschool Site:

Employee Name:

Job Location:

Nature of the charge or complaint:

Date of Event:

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Year20162017201820192020

What I have done to resolve this complaint so far:

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