Language Access Complaint Form :: California Secretary of State

The Secretary of State’s office is fully committed to ensuring that all persons accessing its services are provided these services in an appropriate and timely manner. The Dymally-Alatorre Bilingual Services Act (California Government Code sections 7290-7299.8) requires the Secretary of State's office to provide effective communication to all people utilizing public services. If you feel the Secretary of State's office was unable to serve you because of a language barrier (limited-English proficiency) or other communication differences, the Secretary of State's office may be able to provide additional communication assistance that will assist you with the information or services you have requested.

Please use this form to report any language access complaint you have encountered at the Secretary of State's office.

If you prefer, you can download the form and complete it offline (PDF). Once completed, mail the form and any supporting documentation to Secretary of State, Human Resources office, 1500 11^th Street Room 475, Sacramento, CA 95814, Attention: Equal Employment Opportunity Officer or fax the form to (916) 653-8024.

All fields marked with an asterisk (*) are required.

Section A - Customer Information

Your Name: *

How should we contact you (select all that apply)? *

Your Street Address:

Your City:

Your State:

You have 20 characters left.

Your Zip Code:

You have 15 characters left.

Language Spoken:

You have 5 words left.

Your Phone Number:

Your Email Address:

Confirm Your Email Address:

Section B - Complaint Details

Date of Incident:

Location of Office:

You have 100 words left.

Division or Unit:

You have 20 words left.

Language Access Issues (check all that apply):

Other (explain)

What language did you need assistance with?

Other (please explain)

Brief Description of Complaint:

You have 1000 words left.

Date of Incident:

/ /

Section C - Form Assistance

Did someone assist you in completing this form?

Name of Assistant:

Organization

You have 100 characters left.

Assistant's Phone Number (including area code):

You have 15 characters left.

Assistant's Email:

Language Access Complaint Form

Section A - Customer Information

Section B - Complaint Details

Section C - Form Assistance

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