Employee Portal

A form for CEBA employees to track member interactions.

Contact Name(Required)
First Last
Email(Required)
An email address is very important for Salesforce tracking. If you absolutely do not know the email address, please use [none@none.com].
Company(Required)
Date of Interaction(Required)
MM slash DD slash YYYY
Interaction Type(Required)
Interaction Subject(Required)
Description of Outcome or Action Items(Required)
Two to three sentence summary of the interaction.
Submitter's Name(Required)
Your first and last name for tracking purposes.