Log of Civil Rights Complaints



|Oregon Department of Education |Office of the Director |

|255 Capitol St. NE |Child Nutrition Programs |

|Salem, OR 97310 |971-208-0490 |

USDA Child Nutrition Programs

Log of Civil Rights Complaints

Year: _______________

|Date Complaint | | |Date Civil Rights Complaint Form |Date Civil Rights Compliant |

|Received |Description of Complaint (verbal or written) |Name of Complainant (Optional) |Completed and Returned to Sponsor |Forwarded to ODE |

| | | |(yes/no) | |

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This institution is an equal opportunity provider.

Sponsor’s Civil Rights Coordinator: _______________________________________________________________________

Coordinator Contact Information: _________________________________________________________________________

Log of CR Complaints.doc

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