Family Grievance Form

Current Active Volunteers:
This form should be completed upon receipt of your case. The top portion will stay with the foster parent(s) and the bottom portion should be kept for your records.

CASA of Lexington
Department for Social Services
Division of Youth Services

STATEMENT OF GRIEVANCE PROCEDURE

If you or the child has a problem with a Court Appointed Special Advocate assigned to your case, you should seek first to resolve the problem with the advocate. If, after discussing the problem with the advocate, you are still dissatisfied, then you are encouraged to speak with the Program Director, to attempt to work out the problem. The telephone number is 859/246-4313 and she can be contacted between the hours of 8:30 AM. and 5:00 PM, Monday through Friday.

                                      Detach at line and leave top portion with caretaker/child

STATEMENT OF GRIEVANCE PROCEDURE

              If you or the child has a problem with a Court Appointed Special Advocate assigned to your case, you should seek first to resolve the problem with the advocate. If, after discussing the problem with the advocate, you are still dissatisfied, then you are encouraged to speak with the Program Director, to attempt to work out the problem. The telephone number is 859/246-4313 and she can be contacted between the hours of 8:30 AM. and 5:00 PM, Monday through Friday.

I have received a copy of the above and understand how to direct my comments.

________________________________________________________
Parent, Guardian or caretaker/Date

________________________________________________________
Juvenile/Date

Form was explained and provided to above individuals:

Volunteer  signature/date ___________________________________________