Paid Family and Medical Leave - Story Collection Form
Nearly everyone, at one point in their life, will need to take time to care for themselves due an injury or illness, welcome a new child, and/or care for a family member. Elected officials need to hear from you about why care can't wait, and why Vermont must enact a universal paid family and medical leave insurance program now. If you are interested in sharing your story, please fill out the following Google Form and we will be sure to follow up with you! 

You can also record a brief video message about why paid leave matters to you HERE
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Phone Number
City, State
Gender Pronouns
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What type of Paid Leave Story do you have to share - Personal Medical Leave, Bonding Leave, and/or Family Caregiving - Check all that apply
What perspective are you bringing to this story - Are you the individual who needed leave, the person who has provided leave or perhaps a service provider who has seen the impacts of leave on workers and their families?  Please check all that apply.
Please share your story? What were the circumstances for you to need leave? Did you have access to paid leave? What were the IMPACTS of having or NOT having paid leave on your household? If you are speaking as a service provider, please share the story from your unique perspective.
Are you willing to share your story publicly? This could be in a variety of forms - social media sound bites/quotes, letters to the editor, short video, testimony etc. Please know that the coalition will help you craft these messages and if you need to, you can remain anonymous.
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Do you have any questions or is there anything else you would like to share?
Which coalition partner are you associated with? Check all that apply
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