File a Complaint--General

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Describe Your Complaint in Detail

Full Name, First and Last *

Today's Date *

YYYY

Organization, event or business where incident occurred. *

Please give us a detailed description of the incident. Include as much information as possible, including dates and names. *

Contact Info

We ask for info like your address so we can determine your Iowa Representative and Senator.

Address *

How would you like to be contacted with updates about your complaint? *

Phone

I would prefer not to be updated

Email *

Phone Number *

Would you prefer that we keep your last name redacted (Jane D. instead of Jane Doe) if this complaint is shared or used for educational purposes? *

Yes

I would love you to use my full name

By submitting your complaint and checking the box below, you authorize Iowans For Informed Consent to share information contained within your complaint with legal advisers, governing bodies where formal complaints are being filed, legislatures (for the purpose of enacting legislation) and redacted versions of your form for educational purposes(redacted for educational purposes unless stated otherwise above).

Do you agree with the above statement and terms? *

Agree

Required

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