• [Latino Program]
You may complete a complaint report if you have a complaint against a provider. Anything you think may be inappropriate may be reported. Nothing is too small. Once this form is completed, the information will be forwarded to the Division of Child Development. You may remain anonymous, but we ask that you complete as much detailed information as possible. If you include your personal contact information, it will be kept confidential, and you may be contacted and/or informed about the investigation.
CONTACT INFORMATION

PROVIDER
YOUR NAME

HOME PHONE
WORK PHONE

ADDRESS
PROVIDER INFORMATION

PROVIDER / FACULTY NAME
DIRECTOR

PHONE
  

LOCATION / ADDRESS

COMPLAINT