Story Collection Form

Share what you’re seeing in your work. Every story helps us record the harm the public charge rule is causing and helps us advocate for better policies before leaders and lawmakers. This is for direct service providers speaking in their individual, personal capacity, and you may choose how you’d like your story to be used and whether you’d like to opt in to future advocacy and training opportunities.

Step 1 of 3

About You

Which best describes your role?(Required)

What state do you work in?(Required)

Note under question: This is what will appear publicly if you choose the anonymous tier in section 3.

What kind of organization do you work for?(Required)

A note for public employees: Looks like you work for a government agency or school district. Public employees sometimes have extra guardrails around speech — things like the federal Hatch Act or state ethics rules — that can affect how openly you can speak on political or policy issues, even in a personal capacity.
Because of that, we’d suggest the anonymous (“role + state only”) option next. And if you’re able, it’s worth a quick look at your agency’s ethics guidance, or a check-in with HR or legal, just to be safe. (This is general info, not legal advice tailored to you.)

How would you like your story to appear?(Required)

Role + state only (recommended) – may be quoted as “A case worker in Ohio told us…”; name and employer never public

Named, on the record – your name may be attached and shared with press or government officials, with your permission

A note for staff at organizations receiving federal funding: While signing this letter does not constitute lobbying, some federal grants carry their own broader conditions on political or public advocacy, or have internal policies asking staff to be cautious about public activity, even in a personal capacity, out of concern for how it might be perceived by funders. If you’re able, it’s worth a quick look at your organization’s grant conditions or advocacy policy, or a check-in with your compliance office or supervisor, just to be safe. (This is general info, not legal advice tailored to you.) Your voice is valuable and essential in documenting this harm and it deserves to be heard. We share this caution to uphold our values of transparency.

Contact and Verification

This information is used to confirm you’re a real, working provider, and to reach you if we have follow-up questions. What happens to it next depends on the option you chose in Section 2 — see the note on each field below Only designated PIF staff can access this section. Your email, employer, and phone number stay private — we only ever share totals, like how many signers are in a given state. Your name stays private too, unless you chose ‘Named, on the record’ above, in which case it may be published or shared with press, Congress, or Attorneys General, as you chose. Want your info deleted? Just email data@pifcoalition.org.

Name(Required)

If you selected ‘Named, on the record’ in Section 2, this is the name that will appear publicly. If you selected ‘Role + state only,’ your name will not be published

First Last

Email(Required)

Used for verification only. Never listed publicly regardless of which option you chose in Section 2.

Employer/Organization(Required)

Used for verification only. Never listed publicly, regardless of which option you choose in Section 2.

Address(Required)

ZIP / Postal Code

About You

Contact and Verification

Your Story

Review & Submit

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