You may fill out this form to file a complaint with Oregon Advocacy Center. Instead of filling out this form, you may make your complaint in a letter or e-mail, or you may explain your complaint in person, over the phone. We will be glad to provide any help you need in making your complaint. Your complaint must be returned to us, at the address below, within 30 work days following the decision of this agency with which you disagree. Please send it to the attention of the Executive Director. E-mail complaints should be sent to: welcome@oradvocacy.org.

If you use this form, please complete all sections that apply to your concerns and sign and date below; also give your address, telephone number and email address, if you have one. Attach other information that you would like us to consider. All information you provide is considered confidential in accordance with the Oregon Advocacy Center Grievance Policy.

Please describe the type of help that you requested from Oregon Advocacy Center:

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I was told that Oregon Advocacy Center would not provide me services. 

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I am unhappy with the services that I am receiving because:

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I disagree with the decision of Oregon Advocacy Center to limit services to me or to close my case. I was told about the decision on this date:_______________ 

I disagree because:

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I believe that Oregon Advocacy Center has treated me unfairly or has not carried out its legal obligations, because:

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NAME:    _____________________________

SIGNATURE: _________________________

DATE: _______________________________

ADDRESS:_________________________________________________________________

TELEPHONE: ________________

PLEASE ATTACH ADDITIONAL EXPLANATION IF NECESSARY.

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Send this complaint to:
Robert Joondeph
Executive Director
Oregon Advocacy Center
620 SW Fifth Avenue
Fifth Floor
Portland, Oregon 97204-1428

Voice: (503) 243-2081
TTY: (503) 323-9161
Toll Free Voice: (800) 452-1694
Toll Free TTY: (800) 556-5351
FAX; (503) 243-1738

NOTE: If you need help filling out this form please contact OAC.