Client Grievance/Complaint Form

Community Action Agency of Greater Kansas City customers are treated fairly without regard to race, color, sex, national origin/ancestry, religion, disability, veteran status, and any other characteristic protected by applicable affirmation laws.

It is our intent to provide professional services to customers who apply for individual programs we administer. If a customer has a grievance/complaint and/or suspects fraud and/or abuse or any misconduct of CSBG staff, he/she should immediately contact the manager of the program involved for resolution. Contact information will be provided by the Receptionist.

Your Information

Client Name(Required)

Prefix First Last

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Alternate Phone

Best Time to Call(Required)

Client Status

Current Client

Former Client

Grievance

Date of Incident(Required)

Time of Incident(Required)

Additional Information

Program Involved(Required)

Youth Services

Supportive Services

Healthy Homes

Weatherization

Other

Nature of the Grievance:(Required)

Permission Please review our updated privacy policy.

Security

Please check the CAPTCHA box to prove you are a human, not a hacker. Then select the “submit” button to send your request to a member of the CAAGKC staff. Please allow two business days for a reply.