Complaint Form | HeadStart.gov

Provide Information About the Head Start Program

Tell us the name of the Head Start program. The more information you provide, the easier it will be to address your matter.

Agency Name

Address 1

Address 2

City

State

Zip Code

Contact Number

Provide Information About You

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Confidentiality Preference:

I waive confidentiality.

It is okay to release my name in order to investigate this complaint.

Keep my identity confidential.

I will provide contact information, but please keep my identity confidential.

I wish to remain anonymous.

I understand that I will receive no further contact, either questions or status, about the case.

Name

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Address 1

Address 2

City

State

Zip Code

Contact Number

Describe Your Concern

Provide as much information as you can about your concern, including the date and time of occurrence and any other individuals who were involved.

Name(s) of other people involved and/or affected

Have you reported this complaint to anyone else, including the Head Start program?

Yes

What would you like to see happen to resolve your complaint?

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