Complaint Form - Child Protection Ombudsman of Colorado

File a Complaint

Please complete the form below, including your telephone number, the best time to reach you, a brief summary of your concerns and the agency you are concerned about. A CPO staff member will be in contact with you within three business days of your submission to complete the intake regarding your complaint. *Note: You may also reach us by phone at 720-625-8640.

Age
- Youth - under 18
- Adult - over 18
Your Name*
Your Email*
Your Phone*
Enter a brief summary of the agency or provider’s action or inaction that you are concerned about.
Your Name*
Your Contact Information
- Phone
- Email
Please provide us with the best way for us to get in touch with you.
Phone Number*
Email Address*
Where are you currently living?*
Please let us know if you are living at home or in an out-of-home-placement, such as a Division of Youth Services youth center or foster care. If you are living in a facility of any kind, please let us know which one.
- Home
- Out-of-home-placement
Facility or Foster Care Name
Professional Supports
Please provide the name and contact information of any professional supports you would like the CPO to talk to. This may include your attorney, Guardian ad Litem or CASA. Use the + sign to add additional names.
Name Relationship Email Phone
Family or Friend Supports
Please provide the name and contact information of any family members or friends who you would like the CPO to talk to. Use the + sign to add additional names.
Name Relationship Email Phone
Tell us what you're concerned about*
Please provide a brief summary of your concerns. This may include details about the services, treatment or living conditions you’ve experienced.
Please Read
By submitting this form, you acknowledge that the CPO may attempt to contact you using the contact information you provided or by contacting the facility where you are currently living and asking to speak with you directly. Additionally, by hitting submit, you acknowledge that the CPO may contact the Professional Supports and Family or Friend Supports you’ve listed above.

Confidentiality
Pursuant to C.R.S. 19-3.3-103(III)(3), the Child Protection Ombudsman, employees of the CPO and any persons acting on behalf of the CPO shall comply with all state and federal confidentiality laws that govern the state department or a county department with respect to the treatment of confidential information or records and the disclosure of such information to the treatment of confidential information or records and the disclosure of such information and records. These laws include, but are not limited to, the Colorado Children’s Code, CAPTA, HIPPA and FERPA.

Name	Relationship	Email	Phone

Name	Relationship	Email	Phone