OCO - Complaint Form

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OCO Complaint Form

Information About You (will be kept confidential)

* Indicates a required field.
Name *
Address *
City *
State *
Zip Code *
County *
Email Address *
Daytime Phone *
Cell Phone *
Your Relationship to the Child or Children *

Complaint Filed Against Michigan Agency

* Indicates a required field.
Name of Agency or Agencies: (County DHS and or Private) *
Names of caseworkers involved *
County where agency is located *
If court is involved, in what county was the abuse and or neglect hearings?
Type of case (check all that apply):	Children's Protective Services Foster Care Adoption
Have you tried to resolve your concerns by contacting the caseworker or supervisor?	Yes No
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.

Information About the Children You Are Concerned About

* Indicates a required field.
Name(s) of the Child(ren): *	Date of Birth*	Parent's Home/Foster Care/Relative Placement, etc. *





List Other Adults Involved In The Situation Name(s) of the Parent(s), Step-Parent(s), Legal Guardian or Other Adult(s) *	Date of Birth	This Person's Relationship to the Child *

Your Concern

Specifically describe your concerns about the agency or agencies involved.

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.