File a Report

Indicate which organization this report is for.

 Manasota
 Northern MS
 Northern NV
 Northern AZ

Physical address where incident occurred.


Are you an employee?

 Yes
 No

Do you wish to remain ANONYMOUS for this report?

 Yes
 No

If you want Goodwill to know your identity, please complete the following:


Name


Phone Number


Best time to contact you


By giving us your email address, you will be given a unique "RPT ID#" and allows us to communicate with you via email. All further dialog relating to this report should reference this number.


Email Address



Incident Information:


Report type


#1 Name of person & title:


#2 Name of person & title:


Is management aware of this issue?

 Yes
 No
 Don't Know


Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move