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INTERPRETER COMPLAINT FORM
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PLEASE NOTE:

In order for us to serve you better, please fill out this form if you have a complaint or suggestion regarding language access services. Provide as much detail as possible. You do not have to give your name or contact information if you do not want to, but it will help us investigate your complaint.

Your complaint will not become part of your case file. Do not use this form if you have a complaint about the outcome of your case.

If you want to provide other comments and suggestions ( not a complaint ), fill out Part 2 of this form, under "Give Us Feedback."

CONTACT INFORMATION
  Today's Date:
  Please select how you would like to be contacted  
   Best Contact Method:    US Mail   Email   Telephone   Anonymous
  TO GET STARTED: Select a Contact Method above.
Name:  
Telephone:  
  Address 1:  
  Address 2:    
  City:  
  State:  
Postal Code:  
  Email address:  
   
   Primary language you Speak and Write  
  Spoken:   
  Written:   
   
    If you are filling out this form for someone else, what is their name:  
  Name:   
   
   Tell us when (date) and where (location) this happened.  
Incident Date:
  		      
(if known)   
Case Number:  (if any)  
  Location:    
  Interpreter's Name:   
  Badge Number:  (if known)  
   
PART 1 - Please describe what happened. Check and fill out all that apply
   
   
   
   
   
   
Select at least one item above.  
   Please describe what happened  
  ( Example: Why are you not satisfied with the interpreter, what occurred, what is wrong with the form or other problem you had with court staff. )  Provide as much information as possible.  
   
  Please describe what happened above.  
    Have you complained to another agency about this problem?
 If YES, what is the name of the agency? YES NO
  
   
  Please check Yes or No  
    Please provide any other information that may help us review your complaint:  
   
   
PART 2 - PROVIDE US FEEDBACK
    Other comments or suggestions:  
   
 
   
Do you want us to contact you regarding your feedback?     YES    NO   		 
  Please check Yes or No