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2. Disclaimer

   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.

4. Contact the Human Services Department

   To contact the Human Services Department by email, please complete the online form provided below. We welcome your questions, comments and suggestions. Responses are provided Monday through Friday, 7:30 a.m. to 5:30 p.m.

6. Name*
8. Email*
   Please provide a valid email address. All personal information is kept private and used on our end to better assist you.
9. Phone
11. Comments or Questions*
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13. 1. Receive an email copy of this form.
14. Email address

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15. Submit

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