updated 12-15-2012

Report Your Positive Story

Basic Information

Location (where it happened): *
If 'Other', please briefly describe
City or Town where it happened: *
State *
Date it happened *Exact date is not necessary, please give an approximate date.
Who was involved (strangers, co-workers, boss, etc)?

In Your Words: 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?
What Happened

About You

This story is about a positive experience by: *
MyselfSomeone 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, do NOT call before: HHMMAM/PM
Weekdays, do NOT call after: HHMMAM/PM
It is OK to leave a voice message from MTPC:
YesNo
Comments

Verification

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