COMPLAINT FORM

Dispute Resolution for Children and Families

If you wish to file a complaint related to the Clark County Department of Family Services, please complete this form and submit below. Please be specific in describing your complaint. If you have questions, contact the Ombudsman at 1 (866) 780-9541.

Name of Complainant:

Home Address:

Phone:

Email Address:

Complainant's relationship to the involved child or sibling group:

Name(s) of involved child/ren:

Names of parents:

What is your complaint? (Describe the department's action or inaction you are complaining about. Include dates of incident.)

What outcome are you seeking? (Please be specific.)

♦ This form is for filing a complaint related to the Department of Family Services. To report child abuse, please call the Child Abuse Hotline at (702) 399-0081. ♦