COMMENT / COMMENDATION / COMPLAINT

Thank you for taking the time to express your opinions about the
Office of Disability Concerns and its services.  Your feedback
will help us improve.  If you are submitting an employee
complaint or commendation, please be as specific as possible.

Please complete and mail to address below or fax (405) 522-6695

	Director
	State of Oklahoma 
	Office of Disability Concerns
	2401 N.W. 23RD ST., STE. 90
	Oklahoma City, Oklahoma 73107-2423

Name:____________________________________________________________
Street Address:__________________________________________________
City:  _______________________________  State:  _________________
Zip Code:___________
Home Phone:__________________    Work Phone:_____________________


What kind of comment would you like to make? (Please circle):

 Comment / Commendation / Complaint

What about us would you like to comment on? (Please circle):

 Employee / Process / Other / Accessibility Compliance

Approximate Date and Time of Incident:
_________________________________________________________________

Note:____________________________________________________________
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