Paid Leave Works for WV Story Form
This form will be used to collect your Paid Family Medical Leave story and support work to make this policy a reality for West Virginians. Please complete this form to the best of your ability. If you have questions about this form, please contact Sammi Brown at By completing this form, you are agreeing to be contacted by a representative from Paid Leaves Works for WV to discuss your story.
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Email *
First Name: *
Last Name: *
Email: *
Phone Number: *
City/Location: *
Your preferred method of contact (check all that apply): *
How has paid leave impacted/benefitted you OR how would paid leave have impacted/benefitted you if you had access to it? (Please include details of your personal story here) *
How do you want to share your story and advocate for paid leave for West Virginians? (Check all that apply) *
Are you affiliated with an organization that would want to join Paid Leave Works for WV? If so, please list the name and best contact below:
Please list any other questions, concerns, or needed accommodations below:
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