Report Issues in your Community

[{"type":"text","subtype":"email","required":true,"label":"Email","name":"email","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email Confirmation","name":"email-confirmed","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<b>Issue Information</b>","className":"d-block"},{"type":"textarea","required":true,"label":"Description of Issue","name":"issue-description","subtype":"textarea","rows":5,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"file","label":"<b>Upload an Image of the Issue?</b><br>Please select one or more files for upload. You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format. To upload multiple files, please hold control while clicking on multiple files before clicking \"Open\".<br><br>Optional: Please select one or more files for upload. You may upload files totaling up to 20 MB max.<div><br></div>","name":"uploaded-files","subtype":"file","multiple":true,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"Please do not submit any confidential, proprietary or sensitive personally identifiable information (e.g. Social Security number; date of birth; driver's license number; or credit card, bank account, etc.) via this form. Call our office if the information you want to provide us is confidential or sensitive.","className":"d-block"}]