Request edit access
Paid Leave Personal Stories
We are looking for families, workers, and business owners to share how they have been personally impacted by paid family and medical leave in the US.

Thank you for taking time to share your personal story here. If your personal paid leave story is selected to share publicly, a member of our team will contact you. Press/Reporters will not have access to your information, unless you agree to be contacted only after speaking with our team.

Your information will be protected and stored with the National Partnership for Women and Families. More information on our campaign can be found here: - https://www.nationalpartnership.org/our-work/economic-justice/paid-leave.html 

Please contact sshelly@nationalpartnership.org if you have any questions regarding this form.
Sign in to Google to save your progress. Learn more
First and Last Name *
City, State *
Age + Ethnicity *
Which organization recommended your story? *
CONTACT INFO - Phone / Email *
OCCUPATION / INDUSTRY *
YOUR STORY: How has paid leave impacted you, your family or employees? (Please be succinct, we will also contact you  after submitting this form) *
Have you shared your story publicly or with the press? If so, please feel free to provide links to interviews/ coverage. *
Are you comfortable with us using your image, provided by you for social media graphics? *
Would you be able to attend a press covered event in support of passing paid leave? *
Are you OK with sharing your story with reporters who want to highlight the impact and need for paid leave? (We will prepare you in advance) *
Do you know anyone else who wants to share their paid leave story? If yes, please enter their contact info in the next box *
What is their contact info? - Name, Email, Number
If chosen to share your story, you may be asked to attend a screening interview and storytelling training. When are you generally available for a phone screening? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of National Partnership for Women & Families.

Does this form look suspicious? Report

Google Forms