THE OKLAHOMA COMMISSION ON CHILDREN AND YOUTH

Online Foster Parent Complaint Form

**PLEASE BE ADVISED THAT ALL INFORMATION SUBMITTED ON THIS FORM WILL BE COLLECTED
BY THE OKLAHOMA COMMISSION ON CHILDREN AND YOUTH AND FORWARDED
TO THE OFFICE OF CLIENT ADVOCACY (OCA) FOR INVESTIGATION**
The Office of Client Advocacy (OCA) maintains confidentiality of the reporting party.
Foster Parent Information
Are you an approved Foster Parent or Kinship Placement?
If you are not an approved Foster Parent or Kinship Placement, do not complete this form; contact OCA for further instructions at 405.522.2720 or 800.522.8014 or email at OCA.Intake@OKDHS.org.
 
Name (First, Last) (Required)
Address Line 1   (Required)
Address Line 2  
City, State, Zip
(Required)
Daytime Phone At least one number is required  
Evening Phone  
Email Address  
  (If provided, a confirmation email will be sent to the address provided)
Complaint

Nature of Complaint

If other, explain here

What is the complaint? Please state the facts, such as, who, what, when, where, how and why. If known, what law or policy was violated?

(Required)

What is the requested resolution to this problem (what would you like to see happen?

(Required)

Approximate Date Problem Occurred

Month Day Year

(Required)
Who's Involved
Does this problem involve employees of the Department of Human Services?

If yes, list the name(s) of all Department of Human Services employees involved, if any, in the problem listed above.

DHS Employee Name(s)
Does this problem involve employees of a child placing agency?

If a Child Placing Agency is involved, provide the name of the agency and the name(s) of all Child Placing Agency employees involved in the problem listed above.

Agency Name Employee Name (First Last)
Does this complaint involve a child(ren) in Foster Care?

If yes, provide the names of the child(ren) involved.

Previous Complaint

Have you previously filed a grievance?

If yes, enter the date you filed the grievance.

Month Day Year

If the date is unknown, then leave the date empty.

Have you previously provided information or complained about this issue to any state official, DHS employee, or the Oklahoma Commission on Children and Youth?

If yes, please describe the outcome.

Please provide the name of the person to whom you complained.

If you don't know, then enter "unknown."

Have you testified, assisted, or otherwise participated in an investigation, proceeding or hearing against DHS or a child placing agency?

If yes, please describe the outcome.
 
Mediation

If available, and all parties agree, are you interested in participating in mediation to resolve this issue? Mediation is a way of resolving disputes between parties by using a neutral third party to reach an agreement.

If an email address was supplied, you will receive a confirmation of your complaint for your records. You may also print a copy of the confirmation upon submission. Upon submission, OCA Intake will contact you within two (2) business days.

Accessibility