Comments

Great Lakes Community Action Partnership is committed to providing you with safe, reliable, and quality services and we want your feedback.

Please use this comment form for suggestions, compliments, and complaints. You may also contact us by email or U.S. postal mail at the addresses listed below. Please make sure to provide us with your contact information in order to receive a response.

If you have any questions, call 1-800-775-9767 or email comment@glcap.org.

Section I: TYPE OF COMMENT

TYPE OF COMMENT (Choose One)

Comment

Suggestion

Complaint

Other

ADA Related?

Yes

No

Discrimination Related?

Yes

No

SECTION II: CONTACT INFORMATION

Name

Street Address

City, State, Zip code

Phone

SECTION III: COMMENT DETAILS

Service

Date of Occurrence

Time of Occurrence

Name of Employee(s) or Others Involved

Location of Occurrence

Comments/Regarding Occurrence

SECTION IV: If T.R.I.P.S related please complete

Vehicle ID

Mobility Aid

SECTION V: FOLLOW UP

May we contact you if we need more details or information?

Yes

No

What is the best way to reach you?

Phone

Email

Mail

If a phone call is preferred, what is the best day and time to reach you?

I consent to receive text messages from GLCAP

Yes

Consent for storing submitted data

Yes, I give permission to store and process my data

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