Superior Court of California, County of Madera Language Access Services 200 S G Street Madera, CA 93637 Email: Interpreter.Madera@madera.courts.ca.gov Madera Superior Court Form Adopted for Optional Use MAD - INT - 000 3 (Rev. 3/19/19) LANGUAGE ACCESS COMPLAINT OR COMMENT FORM Page 1 of 1 LANGUAGE ACCESS COMPLAINT OR COMMENT FORM The Madera Superior Court is committed to providing language access for individuals who are unable to understand English. If you believe you have not been provided with reasonable or professional language access, please complete this form and submit it to us in person, or via mail, or via email to the above address. Your complaint will not become a part of your case file. Do not use this form if you have a complaint about the outcome of your case. Please mark one: COMPLAINT COMMENT Complainant Personal Information: (You do not have to give your information if you are only submitting comments.) TODAY222S DATE: NAME: ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE: EMAIL: BEST CONTACT METHOD: MAIL PHONE EMAIL PLEASE PROVIDE AS MUCH DETAIL AS POSSIBLE ABOUT YOUR COMPLAINT/COMMENT BELOW: Case No: To fully investigate your complaint, Language Access Services (LAS) may need to contact you for additional information. Please note that if your complaint does not fall within LAS222s jurisdiction it will be forwarded to the appropriate department for investigation. The Court will contact you within 60 days upon receipt of your complaint. Signature: Date: American LegalNet, Inc. www.FormsWorkFlow.com