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Your POSITIVE Story (in 3 steps):

Thank you for electing to share your story. For your privacy, you will NEVER be identified with this story by MTPC in any way. We will ALWAYS use a pseudonym for you when telling your story, unless you EXPLICITLY direct or permit us to do otherwise.

Part 1: Categorize Your Experience

Where did this happen:

  If 'Other', please briefly describe.  

City or Town where it happened:  

State:  

Approximate date:  

  Who was involved (strangers, co-workers, boss, etc)?
 

Part 2: What happened & what it meant to you

Describe your positive experience. Be sure to include:
  - the action(s) by or words of others
  - how it (they) felt to you
  - where it happened
  - who witnessed it
  - what, if anything, resulted from it
  - has anything like this happened before? if so, over what period of time has this happened?

Part 3: About You

This story is about something experienced by:
  Myself   Someone Else

May we contact you?

It may be helpful to our work if we can ask you a few questions about your story. All contact and identity information will be kept in the strictest confidence and will not be used for ANY other purpose.

I am willing to be contacted by MTPC via the means I am supplying here:

Name:
Email:

Phone:
Weekdays: Weekends:
  From: AM PM
      To: AM PM
  From: AM PM
      To: AM PM
It is OK to leave a voice message from MTPC:
  Yes   No

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