Office of the Independent Ombudsman

Ombudsman Request Form

Complete the online form below, which will be sent to the Office of the Independent Ombudsman.

Requestor Name:

Relationship to Inmate:

Address:

City:

State:

ZIP:

Phone Number: () -

E-mail:

Complaint (Select up to 3)

Ctrl+click to select multiple

Text Check: leave this field blank:

Inmate Name:

TDCJ Number and/or Current Unit (optional)

Date and Unit of Incident: (optional)

Has the inmate filed a grievance on this incident? Yes No

Grievance Number:

Reason grievance was not filed:

Name all inmates who may have information on this incident:

Name all TDCJ employees who may have information on this incident:

Describe your complaint

View the TDCJ privacy and security policy regarding information submitted via this form.