First Name *
Last Name *
Address *
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Phone Number
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Email Address *
To request assistance for an issue you are having with a state agency, please submit the following request form. Staff will follow up by email for additional information, if needed, and to provide updates. Due to the large volume of requests, please allow 5 business days before following up with our office. For assistance with federal issues (i.e. SSI, visas and passports, etc.) please contact your U.S. Congressional Representative. For assistance with county or city government, please reach out to your respective elected official. Please note that we are unable to intervene in disputes with private entities, law enforcement or legal matters pending in a court.
So our office may better assist you, please confirm the best phone number to contact you *
Which California state agency do you need assistance with? *
Applicable Case/Application/Identification Number
EDD Customer Account Number
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Date of Birth *
Have you contacted the agency? *
Have you been in contact with another elected official regarding this issue? *
If yes, who have you contacted?
Please provide a detailed summary of the issue *
Does the Office of Assemblywoman Leticia Castillo have permission to work with the agency to resolve this issue on your behalf? *