Village Complaint or Compliment

2. Report a Village Complaint or Compliment
   The Village of Itasca is committed to providing the highest level of customer service possible. If you would like to file a compliment or complaint regarding any Village employee please fill out the following form.

   The Village of Itasca is committed to providing the highest level of customer service possible. If you would like to file a compliment or complaint regarding any Village employee please fill out the following form.
4. First Name*
5. Last Name*
7. Are you reporting a
   -- Select One --ComplimentComplaint
9. Describe your interaction with the village
11. Date & Time*
    Date & Time

    Date & Time
13. Follow Up
    Thank you for filling out the form, we value your input. Your report will be reviewed by the Village Administrator and followed up as soon as possible.

    Thank you for filling out the form, we value your input. Your report will be reviewed by the Village Administrator and followed up as soon as possible.
15. Would you like to be followed up with?
    -- Select One --YesNo
16. Preferred Contact Phone*
17. Preferred Contact Email*
18. How Would you like to be contacted?

    1. Phone
    2. Email
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field