REA Member Concern Form

Please complete and submit this form if you need assistance from the REA, or would like to bring a concern or question to the REA. Concerns are not limited to only individuals or worksites. If necessary, please share any economic, social, and or political concerns, regarding the REA, that you may have.

Are you a member of the REA? *

Are you a member of the REA? Yes No Not Sure
Name Name * First Last
Personal Cell # Personal Cell # * - ### - ### ####
Personal Email *
Job Title *
Worksite (if you work in multiple locations, please list them) *
On what date did the concern or issue occur? On what date did the concern or issue occur? * / MM / DD YYYY
How many years have you been in your current position? *
How many years have you been in your current profession? *
Contract Status *

Contract Status Annual Continuing Probationary Not Sure
Concern/Question Type *

Please choose the option that best fits your current concern question. Choose other, if you do not see an accurate lable for your concern.
Please list any questions or concerns you have below and someone from the REA office will get back to you within 24 hours, via phone call or email. *