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Major Positive Incident (MPI) Report Form

  1. Major Positive Incident (MPI) Report Form

  2. Was the event/activity a Board-sponsored event?*

  3. If you have a photo to support this nomination, please upload it here by clicking the "Browse" button. (If you have more than one, please contact the Community Relations Department at 837-9253 or 837-9214.) Photos must include the names of all people pictured in the image. Images that include people who cannot be identified will not be used.

  4. Please include the first and last names of ALL individuals pictured in the uploaded photo file. Images that include people who cannot be identified will not be used.

  5. If you have any documentation you wish to share that supports your submission, please attach it here by clicking the "Browse" button.

  6. Consent for Publication Form - Required*

    I acknowledge that the information I am submitting may contain personally identifiable and/or protected information about a person/s served by the Montgomery County Board of Developmental Disabilities Services (MCBDDS). Before submitting this information, I have checked to ensure that the individual/s who are the subject of this submission (and their guardian/s, if applicable) have given written consent for their information to be shared via MCBDDS's Consent for Publication of Personally Identifiable Information form/s, and that this form/s was completed within the last 12 months.

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