Share Your Story with Cover Alabama

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Alabama can protect more families and make health care coverage more affordable right now by expanding Medicaid, and your story can help influence legislators and inspire advocates to take action.

When you share your story, you help make the issue real for people and clearly show what's at stake if we don't take action. With this form, you can write your story, record your story, or request an interview, and it will only take about ten minutes to complete.

By submitting this form, you give Cover Alabama permission to share basic details of your story and use your likeness and image to promote Medicaid expansion in the state. A member of our team may also follow up with you to discuss additional details about your story. If you have any questions prior to completing the form, or if you have any issues with the form, please contact us at coveralabama@alarise.org

Your First Name *

Your Last Name *

Your Phone Number *

Your Email *

City/Town *

Zip Code *

Whose story are you sharing? *

I am sharing my story.

I am sharing a story of a family member

Other:

Race/Ethnicity (optional/check all that apply)

American Indian or Alaska Native

Asian American

Black or African American

Latino or Hispanic

Native Hawaiian or Other Pacific Islander

White

Gender (optional)

Female

Male

Non-binary

Prefer not to say

Clear selection

I am a: (optional - check all that apply)

Parent of child(ren) under 18

Grandparent

Small business owner

Caregiver of a parent, child, sibling or other family member on Medicaid

Healthcare worker

I want to share my story with other Alabamians by: *

Sharing a brief written version of my story

Recording a brief video of my story online

Recording an audio version of my story on my cell phone or other device

Being interviewed by someone from the Cover Alabama coalition (phone or Zoom)

Please tell us about your story. *

Submit

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This form was created inside of alarise.org.