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Instructions for filling out the Intake Form

Make sure that you have read the following carefully before you fill out the form!

  • Due to confidentiality reasons, we do not permit this form to be completed interactively via the internet
  • Please print a copy of this form and complete it prior to your meeting with the Ombudsperson
  • Hard copies of this form are also available in the Office of the Ombudsperson, but in order to expedite the process of your appointment, fill out this form and bring it with you to your appointment
  • Also, remember that you are strongly encouraged to call, and not email, for your appointments
  • Please bring a completed copy of the form to the interview.
  • For any problems, comments, or difficulties: Contact us!