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Civil Grand Jury Complaint Form
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Please complete and submit the form below to the Santa Clara County Civil Grand Jury.

If your complaint includes attachments for the Civil Grand Jury to review, please email them to .
Please reference that attachments will follow via email in this submission if you intend to do so.

IMPORTANT: The Grand Jury does not have authority to investigate complaints involving State or Federal government agencies, non-governmental entities, or matters outside Santa Clara County. The Grand Jury does not investigate all complaints received.

 1. Complaint From:
Complaints may be submitted anonymously; however, anonymous complaints may not contain the information needed to investigate the complaint. Including contact information will assist the Civil Grand Jury in seeking clarification if/as needed.

Last name: First name: Middle:
Title:  Ms.   Mrs.   Mr.   Mx.   Dr.   No Title   Other 

Mailing Address:
City: State: Zip code:
Phone: Cell phone:

 2. This complaint is against:

Name: Title: Agency:

Mailing Address:
City: State: Zip code:
Phone: A value is required.

Be specific; include names and dates. Describe the problem in your own words. All information is confidential.

Please describe any previous attempts to resolve this complaint, including the agencies you contacted and
the action taken by the agencies.

How would you like to see this matter resolved?

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

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