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 419-334-8911 or 1-800-775-9767

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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