Customer Complaint Form

The Tamara D. Grigsby Office for Equity and Inclusion

If you need assistance in completing this form, please contact the Dane County Civil Rights Department at (608) 283-1391.

Contact Information

First Name

Last Name

Address

City

State

Zip

You must enter a phone number or email

Home Phone

Work Phone

Preferred Method of Contact

Complaint Description

Issues Involved

Type of Complaint

What happened? (Include all important times, dates, witnesses and events)

What actions have you taken up to this point?

What actions do you wish to help resolve your complaint?