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 hello.sammib@gmail.com. By completing this form, you are agreeing to be contacted by a representative from Paid Leaves Works for WV to discuss your story.
Email *
First Name: *
Last Name: *
Email: *
Phone Number: *
City/Location: *
Pronouns:
Your preferred method of contact (check all that apply): *
Required
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) *
Required
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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