2. The Office of Community Relations Organizational Ombudsman assists residents who are unable to resolve problems and/or secure access to services and resources directly with various government and quasi-government agencies.

   If you have tried to resolve problems and/or secure access to services and resources directly with a county government and/or quasi-government agency and you have been unsuccessful, please review and complete the questions listed below to receive assistance.

   Please note: The Office of Community Relations Organizational Ombudsman cannot provide legal advice

4. Name*
6. Address*
8. City*
9. State
   -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
10. Zip Code
12. Phone Number*
13. Email Address*
15. How can the Office of Community Relations’ Organizational Ombudsman assist you? *

    Please list dates, points of contact, and other identifying information that will assist with this request

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17. 1. Receive an email copy of this form.
18. Email address

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