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Holland Heroes 2024
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Who We Are
Research
Stories
Media
Movement
Holland Heroes 2024
Donate
Search
Who We Are
Research
Stories
Media
Movement
Holland Heroes 2024
Donate
Who We Are
Research
Stories
Media
Movement
Holland Heroes 2024
Donate
Submit a Story
1
Story
2
Information
3
Consent
Your Story
Story Title
Story Body
Please share your story in 300 words or less.
Upload images or other files to include with this story
Please upload at least one high quality image
Drop files here or
Select files
Max. file size: 10 MB, Max. files: 5.
What is your story about?
Check all that apply
Child Care
Education
Healthcare
Paid Family Leave
Paid Sick Days
Wages/Jobs
Workplace Issues
Your Information
Name
First
Last
Email
Phone
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Consent
I authorize Holland Children’s Institute to record and edit into the Nebraska Story Bank (the “Project”) and related materials such as my name, likeness, image, voice, written testimony, and interview (the “Media”). Holland Children’s Institute may use and authorize others to use all or parts of the Media. Holland Children’s Institute, its successors and assigns shall own all right, title and interest, including copyright, in and to the Project, including the Media, to be used without limitation as Holland Children’s Institute shall in its sole discretion determine.
*
Yes
I consent to Holland Children’s Institute sharing my story and attest that the story I am submitting is true to best of my knowledge and recollection.
*
Yes
Digital Signature
*
By typing your name in the box, you adopt this as your digital signature.
Date
*
MM slash DD slash YYYY
Phone
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URL
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