MORE Community Care and Accountability Request Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is CONFIDENTIAL. Please use this form to send a request for assistance from our Community Care and/or Accountability Teams. We will review all the information that you have provided and will contact you to share next steps. If you need to reach out to the Accountability Team directly, you can reach them at moreacs@morecaucusnyc.org.

Email *

Name *

Please let us know your communication preference. *

Phone Call (please provide phone number in next question)

Zoom

*OPTIONAL* If you selected phone call as your preference, please give us the best number to reach you at.

*OPTIONAL* Do you feel that the issue(s) above would be more appropriately dealt with by Community Care or Accountability?

Community Care

Accountability Team

Clear selection

Pease list the people who are involved. *

Please let us know what happened, give as much detail as you can/feel comfortable sharing. *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms