REQUEST FOR REVIEW OF ILP FUNDS/SERVICES DECISION
If you were not granted Independent Living Program funds or services and you disagree with the
reason for this decision, please complete the following steps:
Email or mail this form to the Los Angeles County Foster Youth Ombudsman (advocate for foster
youth) or call to fill out the form by phone:
)RVWHU&DUH2PEXGVPDQ, Youth Ombudsman Office, DCFS Public Inquiry Section
Phone: (213) 739-6454 Email: pinquiries
@dcfs.lacounty.gov
425 Shatto Place, 6
th
Floor, Suite 604, Los Angeles CA 90020
SERVICES/FUNDS REQUESTED:
DATE OF SERVICES/FUNDS NOT GRANTED: / / NAME OF ILP COORDINATOR:
REASON FOR REVIEW:
(list and attach any other information or supporting document to the form)
DATE:
YOUR FULL NAME: FIRST NAME LAST NAME
ADDRESS:
EMAIL:
PHONE NUMBER(S) WHERE YOU CAN BE REACHED:
BEST DAY/TIME TO REACH YOU:
If this form was filled out by someone other than the youth, contact information:
DATE:
NAME OF PERSON:
ORGANIZATION:
ADDRESS:
EMAIL:
PHONE NUMBER(S):
The Los Angeles County Foster Youth Ombudsman will respond to you in 10 calendar days. If you
have not received a response, please call or email the Youth Ombudsman Office.
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