Suggestion Box

Suggestion Box
This form allows the submission of suggestions for our agency. Suggestions may include your name and contact information or be submitted anonymously. Please note: this form is NOT to be used for reporting emergencies, staffing/scheduling issues, or reporting incidents. If you need to discuss these, please contact our office during normal business hours or for emergencies after hours, the agency emergency cell phone. The numbers are not posted on this public form in order to prevent spamming.

This form is not to be used for sales or employement inquires. Such inquiries will recieve no response.
Date*

MonthDayYear
Date
Please list any suggestions or improvements you may have for the Arc of Vigo County*
Please Indicate your relationship with the Arc*
If your chose "other" in the list above, please explain
Would you like us to contact you about your comment, or suggestion?*

YesNo
Name (optional)

First NameLast Name
Address (Optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (Optional)
Please enter a valid phone number.
Email
example@example.com
Please verify that you are human*
Should be Empty: