Ombudsman Complaint Form 1 Personal Details2 Representative3 Complaint Details4 Submit The Education and Care Services Ombudsman can investigate complaints made about the administrative actions of the Australian Children’s Education and Care Quality Authority (ACECQA). An administrative action is any action taken or not taken by ACECQA (including its contractors) in relation to ACECQA’s duties, functions or powers. The Ombudsman encourages you to raise your complaint with ACECQA first and give them an opportunity to address your concerns before applying to the Ombudsman. If you have trouble completing this form please send an email to email@example.com or call the office on (03) 9654 1077 About You - The ComplainantDo you wish to make your complaint anonymously? Yes, I would like to remain anonymous Note: You can make your complaint anonymously. However, depending on the nature of the complaint, it may be difficult or impossible for the Ombudsman to investigate your complaint fully without some contact details for you. Title*Full Name*PhoneMobileEmail* Postal Address*City*Postcode*State*Please selectAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaPreferred contact method*EmailPhonePostMobileOther Do you have someone who you would like to represent you in your complaint?*YesNoRepresentative’s DetailsWhat is your representative’s relationship to you? (eg Lawyer)*Representative’s organisation name (if any)Title*Full Name*Phone*Mobile*Email* Postal Address*City*State*New South WalesVictoriaQueenslandWestern AustraliaSouth AustraliaTasmaniaAustralian Capital TerritoryNorthern TerritoryPreferred contact method*EmailPhonePostMobileOther Please provide details of your complaint.Details of your ComplaintPlease provide a summary of your complaint. You may attach further documentation if you wish.*ACECQA Information (if applicable)Please provide details if you have them of any contact you have had with ACECQA with respect to your complaint including the names of officers you have dealt with if knownResolutionWhat action or result would you like from the NECS FOI Commissioner?*Supporting InformationPlease attach any supporting documentation including, if applicable, details of any information provided to you by the agency with respect to your complaint. If you are the nominated representative lodging the complaint for someone else, please attach any documents which indicate you are authorised to act for that person. Supporting documentation Drop files here or Confirm and submit.Full Name*I confirm that all the information contained in this complaint form is true and correct.* Confirmed Would you like to receive a copy of your complaint? Yes Email Address* PhoneThis field is for validation purposes and should be left unchanged.