Georgia Coalition for Paid Leave Story Collection Form
Thank you for your willingness to share your story! Please answer the questions below. The information you share will be used to inform our broader paid leave campaign efforts. This campaign is being led by the Georgia Coalition for Paid Leave. For more information on this campaign, see here: https://actionnetwork.org/campaigns/paidleave4allga

Your responses in this form will be kept confidential. They will not be shared with your employer, nor will they be associated with your name. If we use any quotes from your responses in this form they will remain anonymous/de-identified, unless you give us permission to do so. If you have any questions or concerns, please reach out to Allison Glass at allison@9to5.org.

If you are a state, public school, or university employee and would like to share your experiences with the recent paid parental leave benefit (HB 146), please fill out this form instead: https://forms.gle/H1KN5kyvxNt6yNtw9
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Tell me about yourself, your job, and your family. (Example: "I have worked as a school bus driver for 14 years."    "I am a single mother of 2 teenage sons.") *
Have you ever had the option of taking paid leave from your work to care for a new child or a sick family member, or to deal with your own serious illness? *
If you answered "No" to having access to paid leave, please tell us about how this has impacted your life. (Example: "My employer doesn't offer me paid leave, so when I had my daughter, I had to use all of my vacation days to take time off.")
If you have had access to paid leave, please tell us about how this has impacted your life. (Example: "Having paid time off from my job was a blessing when I had my first child. I was able to adjust to becoming a parent without worrying about whether or not I'd still have a job when I came back.")
How has the COVID-19 pandemic impacted your work and family? (Example: “Work is more stressful because we’re short-staffed now.”   "My partner and I are vaccinated, but our kids are not, so we’ve had to be more cautious. Because I still go to work in-person, I’m worried about potentially infecting my kids.”)
If you could not take paid leave from your job during the COVID-19 pandemic, how did that impact you or your family? (Example: "I had to choose between taking time off and losing part of my income, or staying at work and not being able to be there for my sick child.")
How would having paid leave impact you or your family? (Example: "Having that flexibility, to be able to take paid time off from work when I needed to, would really give me peace of mind.")
What would you like to see in the future in terms of access to paid leave for Georgians? What would make it as accessible or useful as possible? (Example: "You can't put a time limit on how long someone's going to be sick, or need to take care of their kid. Having 3 or 6 weeks is a good start, but it doesn't cover everyone's situation.")
Thank you for completing this form and sharing your experiences. If you would be open to us following up with you regarding your responses or would like to receive updates about our #PaidLeave4AllGA campaign, please share your contact information below.
First Name
Last Name
I give permission for my name to be included with any quotes from my story used in outreach and educational materials.
Email
Phone Number
When is generally the best time to reach you? (Example: "Weekends" or "Monday and Wednesday mornings" or "Weekday evenings")
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