First & Last Name

Birthdate

Ethnicity:
–None–American Indian/Alaskan NativeArmenianAsianAsian IndianBlack/African AmericanCaribbeanCentral AmericanChoose not to IdentifyEuropeanHispanic/LatinoMiddle EasternMultiracialOther Racial GroupPacific IslanderPacific Islander/Native HawaiianSoutheast AsianWhite

Gender:
–None–MaleFemaleTransgenderNon-BinaryPrefer not to answer

Phone

Email

Relationship to Child:
–None–Adoptive ParentAttorneyCASACommunity MemberCWS StaffFatherFoster ParentGH StaffGuardianICWA AdvocateILP StaffJudgeLegal GuardianLegislative staffMaternal AuntMaternal GrandfatherMaternal GrandmotherMotherNMDOtherOther RelativePaternal AuntPaternal GrandfatherPaternal GrandmotherPlacement WorkerProfessionalProspective Adoptive ParentRelative Care ProviderSiblingSocial WorkerSocial Worker SupervisorSTRTP Staff

Child's First & Last Name: (If you are reporting on a sibling group, only enter the oldest child’s name here.)

Child's Date of Birth: (If you are reporting on a sibling group, only enter the oldest child’s birthdate here.)

Tell us what you’re concerned about. (If you are reporting on a sibling group, enter the younger children’s names and birthdates here.)

What would you like to happen?:

Once you click “Submit” your form will be sent, you will receive an email confirmation and you will be redirected to the Foster Youth Ombudsperson homepage.