Complaint Form

The information you provide will be used in our effort to resolve your problem and may be shared with the party against which you have complained. Pursuant to 201 KAR 12:060, all complaints must be submitted in writing and list the name of the person(s) filing the complaint. Any information provided on this form may be subject to public disclosure under the Kentucky Open Records Act.

Please provide as much information as possible.

Ex: 555-555-5555

Complaint Information

Ex: 555-555-5555

Please do not enter any Personally Identifiable Information such as SSN, Driver License, or credit card information.

Please do not upload any Personally Identifiable Information such as SSN, Driver License, or credit card information.