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It may be helpful in addressing the issues raised for your story to be shared publicly with decision makers and the media. If you are willing to have your story shared publicly by NCR or Appleseed, please review and agree to the information below. If you do not consent to share your story, your story will still be reviewed and you may be contacted if a systemic issue is raised. In our publications only the first name and last initial will be used publicly unless you are contacted and express consent otherwise. By checking yes, I give permission to the Nebraska Appleseed Center for Law in the Public Interest (“Nebraska Appleseed”) and Nebraskans for Civic Reform ("NCR") and their affiliated organizations to use information gathered about my personal experience in its forthcoming reports, fact sheets, potential litigation, and other materials in print or other media. I also grant permission to share my name and story with other organizations, policy makers and reporters. I understand that my name will be used. I release Nebraska Appleseed and Nebraskans for Civic Reform from all liability and any claims I may have arising out of the use and publication of this material. Further, by checking yes, I confirm that I am at least 18 years of age and that all information in the material that I have provided to Nebraska Appleseed is true and accurate, to the best of my knowledge. By providing this information you agree to waive any actual or potential conflicts of interest as to any facts or persons discussed in your story.