Georgia Division of Family and Children Services Youth Rights Grievance Form Please enable JavaScript in your browser to complete this form.Your contact informationYouth Name *Youth Date of Birth *Youth Contact Number *Best Time to Contact *Name of Placement/Adoptive Family *Youth Email *EmailConfirm EmailYour AddressYouth Address *City *State *Zip Code *County *DFCS Information DFCS Case Manager *DFCS Case Manager Contact Number *Independent Living Specialist *Additional InformationWhat right do you feel has been violated? Please explain what happened. *What have you done to resolve this situation/concern prior to filing a STEP ONE of Youth Rights Grievance (INFORMALS)? *What happened with the outcome during STEP ONE of Youth Rights Grievance process that requires a STEP TWO (If applicable)? *How would you like this situation/concern to be resolved? *Social MediaInstagram Profile LinkTwitter Profile LinkFacebook Profile LinkOther (Please Specify)Please provide contact information for any person who was involved including youth advocate.RepeaterInvolved Persons: NameInvolved Persons: Phone NumberRelationship (to youth) + Add more - RemoveCheckboxes *I hereby certify that the above statements are true and accurate to the best of my knowledge.Submit