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 Child or Children You Are Concerned About
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.