Complaint

An official website of the state of North Dakota. Here's how you know

The .gov means it's official.Official North Dakota websites will end in .gov. Before sharing sensitive information, make sure you're on a government site.

The site is secure.The https:// ensures that you're connecting to the official website and that any information you provide is encrypted and sent securely.

Last Name

First Name

Middle Name

Date

Address

City/Town

State/Province

ZIP/Postal Code

Date, time and place of event leading to grievance

Detailed account of occurrence (include names of persons involved, if any)

Please state policies, procedures, or guidelines that you feel have been violated

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.