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If you believe the Tulalip Child Support Program (The Tulalip Tribes)

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Tulalip Child Support Complaint Form
If you believe the Tulalip Child Support Program (TCSP) has delayed, not taken mandatory action on your
case as required by Tulalip Law or federal regulations or any other concern, please complete this form.
I. Personal Information
Name:
Address:
City/ State/ Zip:
Home Phone:
Cell Phone:
Work Phone:
II
. Type of Complaint A. Please indicate the nature of your complaint by checking one or more of the
categories below:
□ Quality of service □ Staff Conduct □ Staff Performance □ Availability of Staff Resources
□ Disclosure of Information □ Availability of Staff
B. Please use the ―comment section below to provide details about your complaint. The information
provided should directly relate to the type of complaint you marked above in the category section. In
addition, please describe any information provided to you by your case manager. Include copies of any
evidence in support of your complaint.
C. Comments:
Tulalip Child Support Complaint Form
III. Review and Submission Process of Completed Forms
Please return completed forms to the Tulalip Child Support Director in person at the TCSP office located
at 2828 Mission Hill Rd., Tulalip, WA 9827, or via mail to 8825 34th AVE NE, Suite L-545, Tulalip, WA
98271. Upon receipt of this form, the TCSP Director shall review your complaint and notify you of a
determination.
In the event that this complaint is directly related to the TCSP Director, the Social Services Executive
Director will review the complaint. Notification will include, whether or not an error has occurred and/or
if action was taken. Please mail completed forms to the Health and Human Services Executive Director,
The Tulalip Tribes, 6700 Totem Beach Road, Tulalip, WA 98271
IV. Acknowledgement
□I am requesting a review of my complaint.
Signature Date
TCSP Organizational List
Lynne Bansemer – Supervisor
Roseann Reeves – Manager
Carrie Jones – Executive Director
Rochelle Lubbers – CAO
Shelly Lacy - CEO
Board of Directors
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Completed 20 July 2020

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