Language Access Services Feedback Form

Language Access Services Feedback Form

This form collects and records public feedback related to language access services to enhance equal access to public services and programs. The City of Chicago takes reasonable steps to provide all services in at least the top five, most frequently used languages, in addition to English. All information you provide is completely confidential. Please print, complete, sign, and send this form and any related documentation by mail, fax, or email to:


Contact Information

Complaint Details

Incident Description
List the services and documents needed; please be specific. Use additional pages as needed. Print your name on each sheet. If known, include names, addresses and phone numbers of people involved. If you complained to anyone in the department please list their name, position and their response to meet your needs.
(You have 2000 characters remaining)