Formal Complaint Form

Background Information

Whenever possible, we encourage that incidents are resolved directly with the staff or department involved. Often a complaint can be resolved in this way. However, if an informal approach is neither successful or advisable, the Formal Complaint Form should be submitted.

Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Formal Complaint involving(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Involved Parties

Please provide more information about the specific staff person or LFCC department that you want to submit a formal complaint about. This will allow the form to be routed to the appropriate administrator.

Name or Department

Phone number-staff/dept.

Email address-staff/dept.

Additional Information

The Formal Complaint Form should be submitted immediately. This generally ensures the availability of all parties involved in the complaint. When submitting the form, the reporter is expected to respond to all of the following questions as it relates to the complaint.

State the nature of the complaint.(Required) This field is required.

Briefly describe the details of the complaint in the clearest possible language and indicate how the institution violated any rules, policies, procedures, and/or regulations. Materials and documentation used to support the complaint should be attached. The evidence should state relevant facts and document and support the complaint.(Required) This field is required.

Describe the steps taken to resolve the complaint informally. Describe the action taken to date and provide a copy of the institution's response as a result of those actions.(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Additional Information

Supporting Documentation

Submission