Skip to content
State of California
California Department of
Corrections and Rehabilitation
Primary Menu
Ombudsman
CDCR: Ombudsman Assistance Request Form
Submitter's Information
First Name
Last Name
Preferred Pronouns
Email Address
Phone Number
Relationship to Offender
Offender's Information
First Name
Last Name
Adult or Juvenile Offender?
Please select...
Adult Offender
Juvenile Offender
Adult CDCR Number
Juvenile CDCR Number
Institution
Issue or Complaint Information
Issue Requiring Attention
Prior Efforts to Resolve
Type of Contact
Ombudsman / SS
Issue
