Feedback Type:
Confidentiality Preference:
Describe the feedback you'd like to share:
Provide as much information as you can about your topic.
Please include the date and time of occurrence and any other individuals who were involved:
Name(s) of other people involved and/or affected:
Have you shared this with anyone else at your Head Start program?
Who did you share your feedback with?
Have you had a face-to-face meeting with the Program Director?
In your opinion, what would be a possible resolution or outcome in this matter?