By sharing your experience, you become a catalyst for change, providing a unique perspective that policymakers and reform advocates need to understand the real-life implications of their decisions. Your story has the potential to influence meaningful reform, creating proactive policies, programs, and systems for children and families exposed to substance abuse, abuse, and neglect.

Name *

First Name

Last Name

Email *

Your email will not be shared.

I certify that I am not a minor, and I am free and able of giving my own consent. *

Yes

I knew someone who grew up in household with: *

Domestic Violence / Abuse / Neglect

Substance Abuse (Alcohol/Drugs)

Financial Struggles

At Risk for Homelessness

Not Applicable

How old was the person then? *

Was the court involved in any decision that affected your life as a child? *

Yes

What year was the decision made? *

State Where Decision was Made *

What County? *

Other Institutions or Public Authorities Involved: *

As a child, I grew up in household with: *

Domestic Violence / Abuse / Neglect

Substance Abuse (Alcohol/Drugs)

Financial Struggles

At Risk for Homelessness

Not Applicable

How old are you then? *

Was the court involved in any decision that affected your life as a child? *

Yes

What year was the decision made? *

State Where Decision was Made *

If no court involvement, select no court involvement.

What County? *

Other Institutions or Public Authorities Involved: *

Tell us your story *

Your story can change the lives of children who once was on your shoes. Feel free to include what decision was made and how that impacted your life growing up. How old were you when the court decision was made on your behalf? If you are submitting a story of someone else, please let us know what your role is on that person's life (e.g. teacher, friend, relative, co-worker, etc.)

If you could turn back time, what would you want your parents, community, or court professionals to do differently or consider? *

Do you understand that by checking the consent checkbox, you will give permission for us to be able to collect quotes from your story to use internally and/or in campaigns without any identifiable details. Signing this form does not give us permission to share anything publicly with identifiable details. *

Yes

Would you like to keep in touch for further involvement?* E.g., Working together to share your story publicly and/or participating in other activities. *

Yes

I declare under penalty of perjury that the foregoing written story I am submitting is true and correct. *

In order for us to share written testimonials, this legal DECLARATION OF FACT must be completed by you. This ensures your submission is truthful and factual.

I agree to the above declaration.

I disagree to the above declaration.

I hereby release this website and its owners from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss or damage due to my submitted testimony. *

I agree to the above declaration.

I disagree to the above declaration.

Do you consent to your story being shared publicly? *

Yes and you can use my first name.

Yes, Anonymously.

No.

I assign rights of the submission to the website so the website can use it. *

I agree to the above declaration.

I disagree to the above declaration.

Thank you!

Unity for Children

#UnityforChildren | ILLINOIS

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The contents contained here is not intended to be a substitute for, or to be relied upon as, legal advice, medical advice, diagnosis, or treatment. Always seek the advice of legal professionals, physician or other qualified health provider with any questions you may have regarding any legal matter or medical condition.